HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! a - & - / / Permit Number:
S. _ J _ t=
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential
Address: r & /77e2 bi l am r/- LULL,
Property Tax ID #: <3 y/5 - 70& - d / 7 - QQQ - Cj Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
1 �5-rcr /-F»Sr 0- foie
LCONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical _Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7 Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C �d �f GI %%Z C'y
Name: Curtis Sammons
Address:1 ,? f d %�1'l P_C'cCtOC.�/C�!'� C1.(—
City: rl- Oct2 State:
Zip Code: Fax:
Phone No. 7 2oZ - %S
Company: Custom Air Systems, Inc.
p y�
Address: 1615 SE Village Green Drive
City: Port Saint Lucie State: FL
Zip Code: 34952 Fax: 772-335-1968
Phone No 772-335-3232
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
—_--
E-Mail custairsys@aol.com
State or County License CAC051810
-- -- - - - - - -• ... . -1 - �•�-�����+�-a/ ..UL LC YI wrrunencememi is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF Q-)
The for oing instrument was acknowledged before me
this i, day of J� Ce/�� F1 �t� , 20�by
The forgoing instr ent was acknowledged fore me
this 4 - day of sLLIQEtJ ZO l y
h T l <S .-6 ni in 0 n.S
eu R T S /YjQ f� S
Name of person making statement.
Name of person making statement.
Personally Known =,; OR Produced Identification
Type of Identification
Personally Known OR Produced Identification
Type of Identification
Produced
Produced
G
2
iry
(Signature of Notary Public- State of Florida)
n S , t 2ot!�.t ►�8e CHRISTINE 6 EN
Commission No.G?ut 25`�L } f MYCOMMISSIOBN
EXPIRES: Apn7 4,
(Signature of Notary Public- State of Flori�4 �O CHRISTINE 8 ENGL
IS}I j .�°t ��'n
fission No. ®Sa S b * MY COMMISSION#
021 " EXPIRES: ApN 4
�pF p\o Bonded Thru Budget Not
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
52546
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