HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a - a`'� a1 -D Permit Number:
iCOUNTY
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
20300 Virginia Avenue, Fort Pierce FL 34982 tl
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT
//]]LOCATION:
ririracc• 3 /n "I "I+�- 14(JIP, f
Property Tax ID #: '7 925 - 7D %" 023 5-- 0076) ' Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
V'
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
3
Cost of Construction: $ ° (� Utilities: Sewer Se _ _Septic
P
—Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameCkQilt-S c� T 1� qf'; CIG
l� i (i K
Name: Curtis Sammons
Address: $I C>C1 q-tn-
'br
Company: Custom Air Systems, Inc.
Address: 1615 SE Village Green Drive
City: Poy�- Sarni Loci -c-
Zip Code:.3 t495e�-- Fax:
Phone No.7`I2-y0�-(,(097 o, x.03-c16Y-
E -Mail:
State: r4-
6 232
City: Port Saint Lucie State: FL
Zip Code: 34952 Fax: 772-335-1968
Phone No 772-335-3232
E -Mail custairsys@aol.com
Fill in fee simple Title Holder on next
from the Owner listed above)
page ( if different
State or County License CAC051810
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requrreo.
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 RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �� zC1p_�_tCOUNTY OF It o�C/_f'C<
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this X(e day of Few 20 y0 by this 3 (e day of Fe -b 20 R0 by
(� 6 TIS Yf do X O n.5 (. U q Tl S 6X;V h?O/ S
Name of person making statement. Name of person making statement.
Personally KnownOR Produced Identification Personally Known ,i OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State of Florida )
CHRISTINE B EN,
Commission No. en D52S`>!� * f MYCOMMISSIONXC
m� EXPIRES: April 4.
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary Public- State of Flori
rot .. ,,vc CHRISTINE B E
ISH
MY COMMISSION #
mission No. Gz �v Qsa 5 q 6
EXPIRES:Aprg
)11 ''For fto�`c Handed nvu Budget N
SUPERVISOR
I PNS REV EW I VEGETATIREVI WON I SEATURTREV EWLE I M EVIEWVE