HomeMy WebLinkAboutRuble Marsha AC changeout permit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LF
444*R.i
Building Permit Application
Planning and Development Services
Buildingand Code Regulation Division g Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address:AM k i ILI
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
he
New Electrical Meter Second Electrical Meter
Additi al work to be performed under this permit—check all that apply:
Yechanical Gas Tank Gas Piping Shutters Windows/Doors Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
Name N a m e:'<3 IDS.
Addre I Company: S V) 1+r
City: oY St/ate Address: gfl n
Zip Code: 7 Fax�72 37 77i city: r
Phone Na. '� Zip Code: Fax:=_&U _,T_v
E-Mail: ��'? Phone No ZS
Fill in fee ample Title Holder on next page(if different E-Mail G
from the Owner listed above) State or Aunty License
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.
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, 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 an attorney before commencing work or recording our Notice of Commencement.
JU,
Si f Ow no Lessee/Contractor as Agent for Owner n rye 'Cont a or/License Holder
STATE OF FLORIDA �� STATE OF COUNTY OF
/ , C'�
COUNTY OF � (•u
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Sworhto(or affirmed)and subscribed before me of Swo to(or affirmed)and subscribed before me of
<�/ hysical Presence or Online Notarization J Ph sical Presence or Online Notarization
this' day of DAJOb p.0 2024 by this day of Dt,&�202A by
►'OsSI'rir F��c V FOSS
Name of person aking statement. Name of person ma King s atement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
• �� Q.
(Signature of Notary Publi (Signature of Notary Publi
Notary Pub4K State of ponds y. Nogry PUblit State of Flw4a
Commission No. Craig A,Groaaman Crap�'ossman
My �twa1(3G ti6306o ommission No. My gi@m"I"Os a 98706ti
a R� Exoms 06/10/20 44 «� Expires 05110r2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.