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All APPLICABLI INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to Il3 ZZ 1 Permit Number:
„i
. ` ` Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial` Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
I
Address: �k0 Ii wa ln,
Property Tax ID #: 342- l b) 54 Lot No.�s
Site Plan Name: 1 I Block No.
Project Name: M iTC� e w\ (US: c. c0—
DETAILED DESCRIPTION OF WORK:.
1�
New Electrical Meter Second Electrit'al'reter (Affidavit required)
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name VVA!±)JGlw.c_b Wj+C":
Name: G(i {o,,d
,-8
Address: I �) t ca
Company. tr/a. �ti
r:Sb d 6 cr 6ff
City:_ 1- tatefl-
Zip Code: �N�S�_ Fax:
Phone No.
Address: lI
fir,
City: ? s �
Zip Code: 399!S '
Phone No -),a-
State: VC�`
Fax:
4 G I - I WN
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 101-@ (7ruwc �Q c�uy , ts,N.
State or County License CA C056 *4-e
-- ---- -•--••-••- •-•• •� -��� �• •••.., �, a nc,vrtucv rvaoce or l.ammencemenL,s required.
If value of HAVC is $7,500 or more, a RECORDED Notj<e of Commencement is required.
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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
BANDING 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.
l 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.
Inconsideration of the granting of this requested perknit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida B�1,ilding 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 an attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for:,Ovmer
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) prid subscribed before me of ..
this 11!7 day Of 20,� 1 by
Personally Known f OR Produced Identificaton
f Identification Produced _
-Signature of No*�tary Public- State of Florida-)
Commission No JA ) 0� 8 {O � (Seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING
REVIEW
SUPERVISOR
REVIEW
Physical Presence or Online Notarization
J ES S I CA GROVE R
?� °�,? Notary Public -State of Florida
Commission # HH 119064
oil : My Commission Expires
April 19, 2026
PLANS VEGETATION SEA TURTLE
REVIEW REVIEW REVIEW
MANGROVE
REVIEW
O COC OR
O $Son PS
'J HEN PSI
U VOL AMPS
O ELE , rdCALCONNEMIONS
O CONTACTS TIGHT& CLEAN
D OIL LEM & CONDITION
❑ CONDENSOR COIL
0.EAN COII a CNECKFa! COND.
❑ ENT F LVG q
O REFRIGERANT
on ❑Telco
❑ FAN AND MOTOR
UvOLTs_AMPS
O ELECTRICAL CONNECTIONS
D coNrACTs ncNr a CLEAN
U FN PULLEYS (ADJUSTSELT)
U CHECN LUB BEARINGS A MOTOR
❑ EVAPORATOR COIL
❑ CLEAN a OIL a CHECK RN
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a ENTWB—°F LVG We-4
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❑ ELECTRICALCOMPTS.
URBAYS ONNTK.'TdiB
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❑ DUCTSYSTEM
STATGPRESSUIRE
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COVERAGES
PREVIOUS
CALLS
.�_..� ..._ _.. _ ..._.
SERVICE
7� z C ,
REQUEST
I f� ,Arc
_-. GO.
DESCRIPTION OF WORK
1 / ISERVICE CALLN
SCHEDULED
DATE 1
a,COMPLETE
D wars ORDER
O NOT HOME
D RESCHEDULE
O OTHER
/5 T
'
95-00.(Do 75-eoCH ti�
— /000•tx - l� .00 TQ re b� ro os�
TIME N ells- OUT
TE
BOO, DO Sup, Od ' TECH Tif 92 IME OUT
PAYMENT
I Aa ' _ 1 have mcelvetl and agree to S11e terms and conditions of my contract. and I understand
Manufacturer I VCCGL,N rKAL^r PART NEEDED
MODEL# — 5 PART NEEDED
wikta$e 283970 057
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sERIALa __ ROA ... _.. .a fi fill 111 II 11111111
BM OR# _ P.O." — - III III III 1111111 11 is If'.—
al parts es rxwdW m wartantsa es por manwcJPer apeslnWlan.
LABOR GUARANTY
The labor charge es recerdod hero
relative to Me equipment serviced as noted. Is guaranteed for a Period of M days.
We do not of course, guermdy other parts than Noes eve Install. It rewhs later become
masesry due to cover defective ports. "wig be oherged aeparafely.
No gummy on any drain stoppages.
PARTS
LABOR
SERVICE
CHARGE
BFS WILL NOT BE RESPONSIBLE FOR PROPERTY DAMAGE WHEN
REMOVING
OTHER
DISCOUNTS
TO PERFORM NECESSARY SERVICE WORK AND I ACCEPT
PERFORMED SERVICE AND/OR CHARGES AS BEING SATISFACTORY
TAX
All sales are final with no adjustments orJefund
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EMAILADDRESS _ I /J CUSTOMER SIGNATURE
vJww,hrowardfactorycom
BFS.2Rov rvsozo Licenses' CAC056778, CAC056774, CAC057400, CFC056867, ES0000336, 0040504, 0046467, 280095, 279402, 289307, 0081113, 0081114, EC13007734