HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S e26 oda O
s: - 3�' =
EOUSI-41
Planning and Development Services
Building and Code Regulation Division
2,300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Permit Number:
Building Permit.Application
Commercial Residential
PROPOSED IIutPRE}lJ[EN3 SCA
Address: Vo lu m
Property Tax ID #: 4Q r- 7G11 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION 'INFORMATION: = -
Additi nai work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
_ Generator
Sq. Ft. of First floor:
Block No.
_ Windows/Doors
Roof Pitch
Cost of Construction: $ 50.'70 Utilities: _ Sewer _Septic Building Height:
OWNER/LESSEE:C£}1{3It:
Name //JQ�rP C'ar��,no �oAals JQ//YLC'117o
Address:
773/off ala W
City: 1-DkT S'r a -/e State:
Zip Code: JVY,s? Fax: 77a S77 qoaSY-
Phone No. 77d 5717 -X07 T.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: CUrJs Sammons
Company: Custom Air Systems, Inc.
Address: 1615 SE Village Green Drive
City: Port Saint Lucie State: FL
Zip Code: 34952 Fax: 772-335-1968 I
Phone No 772-335-3232
E -Mail custairsys@aol.com
State or County License CA0051810
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: i
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address.-
ddress:City:
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."
r
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,� �( t,C COUNTY OF t t.r,c
kaa�-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this a6 day of M ft y 20 ,R O by this a? 16 day of M A b 20Q 0 by
I'Lf LIS Y6Min0n-5 � �1,�I?T15 6/lyN,/�S
Name of person making statement. Name of person making statement.
Personally Known OR Produced IdentificationI Personally Known XOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State of fforicla) (Signature of Notary Public- State of Flori 1
�t otter p�u�e�i CHRISTINE B EN ISH // rot* .. �ev� CHRISTINE B FJ
Commission NoAen05254i6 * f MYCOMMISSION#G issionNo_Gt�l;sas�b * , My COMMISSION#
LL m 0 EXPIRES: April �
'41f
0.\0 EXPIRES: Apn7 4. �D21 �'Foc �e eo:xbd Tiw 3udyet No
REVIEWS I
COUNTER TER I ROEVI W NINGS REVIEWUPERVISI PNS REV EW I VREVIEWON (S REV EWEGETATIEATURTLE MREV EWVE
RECEIVED
DATE
COMPLETED
��� ,�r,�s�a�t � 4
w.._