HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r —7
Date: Permit Number: C 1 03 " 0cQ
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 x
PERMIT APPLICATION FOR: Mechanical
PROPOSED " , TO' ENT LOCATION
Address: Q4�i S-
Legal.Description:
Property Tax I D#:3S�- ' \3 D'c� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Bac : Right Side: Left Side:
DETAILED DESCRIPTION 4F WORK
o`C \
iFl U �3
CONSTRUCTION INFORMATION
AdditionalworKlObenerformed under this permit c ec a app y:
Z✓ HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers 1:1 Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities:0 Sewer OSeptic Building Height:
`OWNER/LESSEE. CONTRACTOR.
Name Name: PATRICK FLETCHALL
Address: l C�W Company: COOL&RELIABLE AIR COND
City: �')ervy%k LQ— State:, Address: 1051 NE SANTA CRUZ DR
Zip Code: 077. Fax: City: JENSEN BEACH State:FL
Phone No. 77'7Z- (Q �2-' 7 � Zip Code: 34957 Fax:
E-Mail: Phone No. 772-692-5750
Fill in fee simple Title Holder on next page(if different E-Mail; r-cool@bellsouth.net
from the Owner listed above) State or County License: PAC058567
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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,1 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 concuirency 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 jobsite
before the first inspection.If you intend to obtain financing,consult with lender or an attorney before
commencina work or recording our Notice of Commencement.
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Sig re of Owner/ ent/Lessee ftaWre of Cont or 'tense Holder
STATE OF FLORI STATE OF FL R{D�,\
COUNTY OF ��Ci(' COUNTY OF
The for oing instr nt was a0nowled ed before me The forgoing instru nt was acknowledged before me
this y day of I/1 200 by this�day of 20,Dby
(Name of erson ack [edging) (Name of person acknowledging)
2"'1
nature of No fry Public-State of Florida) - nature of N ry Public-State of Florida)
Personally Known `- OR Produced Identification Personally Knawn �OR Produced Identification
Type.of[dent ficatloan,PP duced- _. Type of Identification 0� duFed�a` m-
ti 4 JERALYNNE RUSSELL M
Co 61ssio r P e .� JI�R NSal) `' Commission J)ic-State of Florida
-,•n,° MYComrn.Ex •res Jul 22,2017Notary Public-State of Florida
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MV Curnin. Exoires Jul 22 2017 F ,o�=o •� .0 c , on
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
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