HomeMy WebLinkAboutCCF02062020_00001All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
'COUNTY
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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: d°yd"16 �a111J.Q6,-
Property Tax ID #: ,��c� S %�1T %�,2 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
1/P,
CONSTRUCTION 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: $ VGJ� Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name larl1h{ l odl D Name: Curtis Sammons
Address:: fyd6 lJ t�lZ?it�t� �� Company: Custom Air Systems, Inc.
City: / 6,1� I& z �� _ State: FL Address: 1615 SE Village Green Drive
Zip Code:Fax: City: Port Saint Lucie State: FL
Phone No. �I %02 ��5� ��02 Zip Code: 34952 Fax: 772-335-1968
E-Mail: Phone No 772-335-3232
Fill in fee simple Title Holder on next page ( if different E-Mail custairsys@aol.com
from the Owner listed above) State or County License CAC051810
If value of construction is $2500 or more, a RECORDED Notice of Commencement 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
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 contlict 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."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
� L
STATE OF FLORIDA ,c
COUNTY OF i
COUNTY OF l�Ct
VQeu—
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this G day of Fe b 20 aU by
this �p day of F-e b , 20d0 by
i R Tl S .�� M X G n,5
�l4 k Tl S Si5h1 h?O S
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
X
(Signature of Notary Public- State of fforicla)
�,,K,
(Signature of Notary Public- State of Flogs`
prCHRtSTtNE B
Commission No. C 0 5 2 S �l6 AWW COMMISSION /
- CHRISTINEB
�i �y B s a s 6 MY COIN ON:
fission No.* o�
EXPIRES: April 4,
o�
23 ''FpF F� BftW Tin &49d No
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Rev. 2///19