HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number. Ilk�5— 05')
Date:
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Building Perrriit Application St-LudeDEC.
Planning and Development Services
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Building and Code Regulation Division 9 y
LU It)
2300 Virginia Avenue, FortPierce FL 34982 13
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PFRnn,�.INu
ounty, Ff,
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 200 N. El MAR DRIVE JENSEN BEACH, FL 34957
Legal Descri & )EAC 4 I ut3 C, ot�ot 3 y `B 1b b A
45 It -6 I - 6000 - (1�00 ' 3 \
Property Tax I of No.
Site Plan Name: ! Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install double goose neck for existing curbs.
CONSTRUCTION INFORMATION:
bona wor to a erDrme un ert ispermit—checka apply:
0]GasTank
13HVAC ❑Gas Piping Shutters
[[]Windows/Doors
Electric 0 Plumbing Sprinklers Generator L ( Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ - '7.5�-f�'�Q Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam
Name: RICHARD D. WILLIAMS
Address:
l�Yl
Company: R & R SHEETMETAL WORKS, INC.
City: State:
Address: 905 WAGNER PLACE
City: FORT PIERCE State: FL
Zip Code: Fax:
Phone No.�—
Zip Code: 34982 Fax: 772-465-8221
E-Mail: bzwln luloteloopm Qq
Phone No. 772-465-2459
Fill in fee simple Title Holder on next page (if different
E-Mail: rrsheetmetalwork@bellsouth.net
State or County License: CSC056681
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION TM 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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is In con list 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
commencin work or recording our Notice of Commencement.
�y�&Z7J7_uD s
_ Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID STATE OF L l3Gl ti COUNTY OpORIDQ
COUNTY OF �
The fo,{g�qing instru ent was acknowledged before me The forgoing Instrument was acknowledged before me
this day of ,t 1 . 20 j.Gby this day of 20 _4 by
Ebw A Rb 4AiLUAFl J (CK p 1 rd 'n . )'i I ofais:
(Name of person acknowledging) \ (Name of person acknowledging)
a C ,'e 1
(Signature of Notary Public- State of Florida) (Signetur f Notary Public- State of Florida )
Personally Known X OR Produced Identification _ Personally Known vl� OR Produced Identification
Type of Identification Produced Type of IdentificationProduced
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Commission N ( I) Commission No. ° c 5" / �Q (Seal)
• Notary Public State of Florida
ns ne la '
Revised 07 My Commission EE 854353 R/tpp) (sl{OYM
Expires ovosrzon , •pumle r stir of RW"
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