HomeMy WebLinkAboutBuilding Permit Application Y
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: 15 ao 5 Permit Number:
RECEIVED MAY'2 72015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click here Ac-
PROPOSED INPROVtMENT LOCATION: . . -
Address: K:2 /.V-h AbIr Or.
Legal Description: //%y& 47- SAVAA/1 A 5'109 ( j'l� 10-3.9
Property Tax ID#: B26' -707 0 00 - 6 Lot No. 7
Site Plan Name: Block No. 35-
Project
5Project Name: %' ,dJZV A5�-IXI/16&
Setbacks Front Back: Right Side: Left Side:
DETAILED`D.ESCRIPTIO.N.OF`WORK`.
A/C CHANGE OUT EXACT REPLACEMENT
/01'1 / Cp/iylAfV P,�G' y,,w/
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CONSTRUCTION'LNFORMATION:
itiona workto e e orme under this permit-check a appy:
HVAC Gas Tank Gas Piping _ Windows Doors
❑ g Shutters P ❑ /
Electric ❑ Plumbing Sprinklers Q Generator Roof
Total Sq. Ft of Construction: x023 Sq. Ft. of First Floor:
Cost of Construction:$ Utilities:11_Sewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 411 />I/ Name: MARKAVINES
Address: m;z 13. t Oe /^ Company: AZTIL
City: pp S-ToC. 0F— State:FL Address: 2540 S MILITARY TRAIL
Zip Code:NY51 Fax: City: WEST PALM BEACH State:FL
Phone No. ;2/ Zip Code: 33415 Fax: 561-434-0018
E-Mail: Phone No. 561-433-2197
Fill in fee simple Title Holder on next page(if different E-Mail: SAMPOLIT01@GMAIL.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.
t
SUPPLEMENTAL CONSTRUCTION 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:
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
commencing work or recordingyoVNotice of Commencement.
4;�C"el
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF1997 A c# cant n;fl:� COUNTY OF PALM 13 EACH COUNTY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this.27 day of Xbe' 120LL5-j by this,27 day of I-A 20®by
141 J'✓YS !n+IZ/L 1 Y ' I�I��
(Na of person ckn)w dging) (Name of person acknowledging)
(Si ature N ary P ic-S ate of Florida) (Si ature f Nota lic-State of Florida)
Personally Kn n OR Produced Identification ersonally K o _OR Produced Identification
Type of Identific io Type of Identi ca ' —
+¢` "" = JOHN E �, JOHN S®W D GIFFORD
Commission No. a ? Q )RD GIFFORD Commission No. ►: z
�t�MMIS 8N`aalll
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EXPIR '. tX�iI�E�December 17,2017
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