HomeMy WebLinkAboutBuilding Permit ApplicationAI�RPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: d rooq - o
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- Building pp Permit Application
'Planning and Development Services
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Building and ,Code Regulation Division
12300 Virginia Avenue, Fort Pierce FL 34982
'Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential X
;
PERMIT APPLICATION FOR:A/C Change Out
PROPOSED IMPROVEMENT LOCATION:
Address: 6720 Dulce Real Avenue
i
Property Tax ID #: 1 1 Lot No.
Site Plan Name: Block No.
0
Project Name: cu r
DETAILED DESCRIPTION OF WORK
A/C Change Out
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
LMechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing
Total Sq. Ft of Construction:
;Cost of Construction: $ 4575.00
_ Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Robert Blair
Name: Mark A. Vines
Company:Aztil
-Address:6720 Dulce Real Avenue
City: Ft. Pierce State: _
Address:2540 S. Military Trail
Zip Code34951 Fax:
City: West Palm Beach State: FL
Phone No:772-336-2138
Zip Code: 33415 Fax:
E-Mail:
Phone No561-433-2197
Fill in fee simple Title Holder on next page ( if different
E-Mail Permits@aztilac.com
State or County LicenseCAC049253
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUiPP'LEMIENTIAL;CONSTR) CTION `ELFIN LAW INFORMATION:,
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
IZip: 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or rney before commencing work or recordingyoV 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 Paim Beach
COUNTY OF Palm Beach county
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
x Physical Presence or Online Notarization
This 31st day of August 2020 by
this 31st day of August 2020 by
Mark A. Vines
Mark A. Vines
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
eFTTE
'`�:
(Signature of Notary Public- State t -Notary Public -Brat
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Commission # G
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181571
of Notary Public- State of I- Notary Public -Stet
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Commission NO. GG181571 %. M Commission
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On No. GG181571 '��i�`aI) January 3-1.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.