HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0la. • wo0 )
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F134982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical'
PROPOSED IMPROVEMENT LOCATION:
Address: a:�OS031 �
Legal Description. THE PRESERVE AT SAVANNA CLUB-BLK 53 LOT 9(OR 1439-8)
Property Tax ID#: 3425-706-0279-000-7 Lot No.
Site Plan Name: Block No.
Project Name: Rogers
Setbacks Front Back: Right Side: Left Side:
DETAILED"DESCRIPTIO''N :OF WORK:'
KW- 10
TON-3.5
SEER-14.00
CONSTRUCTION INFORMATION. ,
Additional work to e performed under this permit—check a apply:
W1HVAC E] Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing O Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 4800.00 Utilities:Sewer OSeptic Building Height:
0WNtR/LES5EE: >°''CONTRACTOR:.
Name MZA Name: 4wV_
Add r Company: AZTIL
State:FL Address: 2L91ge? �u fL
Zip Code: 34952 Fax: City: State:FL
Phone No.7728347153 Zip Code: 33415 Fax:
E-Mail: Phone No. 561-433-2197
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@,AZTILAC.COM
from the Owner listed above) State or County License: CAC049253
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUIRPLEMENTAL'CO'NSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x—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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commen,pia work or recopAng your Notice of Commencement.
Signature o wne /Lessee/Contractor as Agent for Owner Sig atu Cont ctor/License Ho er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
The for Ring in ment was ackn ledg�d�efore me The for rig instrument was ackn wled ed before me
thisday of 20_ by thiay of 20 by
MARK A VINES MARK A VINES
Name of p rso aking statement Name of ers making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific on Type of Identification
Produced Produced
(Signature of Notary PutLETTE GRECO (Signature o fNotary Pu
""� , NICOLETTE GRECO
Notarr�,P, Vic-state of Florid ,_PP `�a ,
Commission No. Ctaza ion # GG 181571 ommission No. ;° `�.Notary(Iglibfly-State of Florida
<� oQ My Commission Expires - Comri�ission # GG 181571
January 31, 2022 -�5 aP' My Commission Expires
�r������� January 31, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17