HomeMy WebLinkAboutmech/hvacAMA APPLICABLE I
Date:�lap
IVFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Plign n in g and Development Services
8urlding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address: VhL41LP �\Grano '1Z \��(• Y�I��\ I�r\rY�
Property Tax ID #:
L
L4 Lk 2) �0 - Lk C) th - apC8 - cr-n - Lot No.
Site Plan Dame: Block No.
Project fame:
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work, to be performed under this permit — check all that apply:
�Mechanical GasTank _Gas Piping _ Shutters
Electric
Plumbing
Tots! Sq. Ft of Construction:
Cyst of Construction: $ �
OWNER/LESSEE:
Sprinklers
Generator
Sq. Ft. of first Floor.
Windows/Doors
utilities: Sewer _ Septic
Name
Address: \'hLitip
C-1tY:,Ta\MState:
Zip Cade: Lk CiCl 0 Fax:
phone No. to ti �� E-
Mail: _
Fill in
fee
simple
Title Helder on next page (if different
from
the
Owner
listed above)
CONTRACTOR:
Name: t
Company
Address:
Pond
Roof Pitch
n En
Building Height:
City: State: V'I„r
Zip Code: Ll�l fax:
Phone No '1 `1 ��� • � L �7
E-MaiE 0 k a L rw
State or County License -4
if value
of
construction 'is
2500 or more, a RECORDED Nofice of Commencement is required.
if value
of
HAVC is $7,500
or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
City: � State:
7in� Phone
0
FEE SIMPLE TITLE HOLDER:
None:
Address.
City .
Zip: Phone:
Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name:
Ad d r+
city: State:
Zi t Phone:
_
BONDING COMPANY..
lamer.
Add ress
City*
Zip. Phone:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
t. Lucie County makes no representation thatis ra nti n a permit will authorize the perrn it holder to build the subject structure
which conflicts with an a pal iab1 Homeowners
Association rules, lags or and covenants that a restrict r prohibit h
structure. Please co r u t with your Homeowners Association and review our deed for any restrictions h ich 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 concurr ency review: room addition .,
accessory structures, 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 fit.
Lucie County and pasted on the Jabsite before the first inspection. If you intend to obtain financing, consult
with lereder or an attorney before commencing work or recording Notice of Commencement.
IF -Adllsff-� -'I
gna re of owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Ma rVi
Sworn to (or affirmed and subscribed before me of
this day of VCDCuU a6 20 � : by
11-J
U�
Name of person making statement.
Personally Known _
Type tifirnat'fo
OR Produced Identification
Produced
(Signature of Notary Public- State of Florida)
0 ? EMMAPARKMURST
Commission�`� *�
CAM ��
1
Way 20, �4
toe-meof
a ��
Physical Presence or � Online Notarisation
REVIEWS
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FRONT
ZONING
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SUPERVISOR
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PLANS
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VEGETATION
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MANGROVE
COUNTER
REVIEW
REUIEW
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REVfEW
REV EWEA
DATE
RECEIVED
BATE
COMPLETED
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