HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I G/ Permit Number:
S _ J
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:(��//r°Q
Property Tax ID #: �0 '
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
IZ�r Gll'P ,3 S pry l f Sty'/ i�A)IsC afr
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additiogal 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: $ i/ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
-CONTRACTOR:
Namel'err Q ` CCkn �5
Name: Curtis Sammons
-d/��
Address: eo D l� / / LaC.l.rIU l d tar-C i 'l-
Company: Custom Air Systems, Inc.
City: fit - /UCl�- State: ,C--7L,
Zip Code:c3 99,�a Fax:
Phone No. 151 g (p // 0
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)
If value of rnnctrnrfi .n ;� lticnn
E-Mail custairsys@aol.com
State or County License CAC051810
- T---- -I VI,LC Vwmmencemem: is regwrea.
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 RFrORDINr.. YniIR NnTirF nF rnmmirourFwFiuT -
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF J;6— ZLeG
STATE OF FLORIDA
_c.
COUNTY OF
The for,going instrument was acknowledged before me
this C, day of Cef jlLur/ 20�by
The forgoing instrurz ent was acknowledged fore me
' %y
c�2 ,
this C day of /LPCPs1G i20 7
�tt R Ti S S"iin , n;
�(� �? T! S 6�J12 ML/W 5
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Flori
n o"Ay rues CHRISTINE B EN
Commission No.CiGT 052S'(�6 * � MY COMMISSION NG
r°t •����'o CHRISTINE B E
!SH MYCOMMISSION#
nission No. A
P� EXPIRES: April 4
EXPIRES: Apni4.
021 \o�
�oF FL Bonded Ttvu Budget Not
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SEATURTLE
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
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