HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �- �6 -��o� Permit Number:
A
W.0,
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.-
n_.
Address: /D3 �Q /YJl4O 16el W/o
Property Tax ID r: Ly,/IX
J,/X ri- //�` rQD',, - QC,!�J S Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
4—Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First door:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name,cam/pa- e, r
Name: Curtis Sammons
Address: iod 4a-'y111a 'V V'6D
Company: Custom Air Systems, Inc.
Address: 1615 SE Village Green Drive
City: /ea Z S7` �Oc/ State: fl
Zip Code: Jgo2 Fax:
City: Port Saint Lucie State: FL
Phone No. 772 -A'7- 2&6
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
j from the Owner listed above)
�
E -Mail custairsys@aol.com
State or County License CAC051810
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I
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.
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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 J16 ZU4_t
STATE OF FLORIDA ,c
J '
COUNTY OF VCU4
VC
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this /t day of I 102 i L- , 20 A (by
this i E- day of /j F /c `L , 2D�,— by
�'(_/hi T/5 S -RM X,2 n,5
LugT1S 5,;f7t7p/7S
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 fforicla)
rye
(Signature of Notary Public- State of Flori
�t,_ CHRISTINE B E
ot�Y CHRISTINE B E
Commission No.�Gt�5�s�6 * �� f MYCOMMISSION#G
I$}{ ! 20�.. iC,
mission No. (A 0$a 5�6 *A� MYCOMMISSION#�G
EXPIRES: Apni 4.
oEXPIRES: April 4 2
021 FOF F�_ Boned Tlvu li xf9et N
i
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW I
DATF
RECEIVED
DATE
COMPLETED
-
Rev 27771T-
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