HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN U BEC MPLETED FOR APPLICATION TO BE ACCEPTED
Date: f�r Permit Number:
•
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 X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LQCATION.
Address: O 2'�4O Ln
Legal Description: 4:3nhn 1 C�e - P�,Q ) - -��p GYrid 71&2;(-Qtr-f-- oIP�c�
3U ngeserye_ LIQ„ oa -- Pham_(
Property Tax ID#:332 1 -vpI -m.?w> - COO Lot No. ,?Q
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF`WORK
CONSTRUCTION INFORMATION:
Additional work toa orme under this perms -c ec a appy:
✓HVAC E]GasTank Gas Piping _Shutters Windows Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of.Construction: S Ft.of First Floor:
Cost of Construction:$ 5g 00-DO Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name t Name: PATRICK FLETCHALL
Address: 1-7 Company: COOL&RELIABLE AIR COND
City: 72-14:21 )emn Stater Address: 1051 NE SANTA CRUZ DR
Zip Code: _moi Cam I Fax: City: JENSEN BEACH State:FL
Phone No.(—d) Zip Code: 34957 Fax:
E-Mail: Phone No. 772-692-5750
Fill in fee simple Tide Holder on next page(if different E-Mail: r_cool@bellsouth.net
from the Owner listed above) State or County License: CAC058567
If value of construction Is$2500 or more,a RECORDED Notice of Commencement Is required.
SUPPC�MENTALCUNION LIEN LAW'INFORMATION a
DESIGNER ENGINEER: . _Not Applicable MORTGAGE COMPANY: _Not-Applicable
Name: Name:
Address: Address:
C. 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.l 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 recording our Notice of Commencement.
Sig re of Owner/ int/Lessee ature of Co7RID
or icense Holder
STATE OF FLORIDA STATE OF FLA� ) �1 P
COUNTY OF LlLel' 2 COUNTY OF l �l
TheforgQ j'n�g instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 'tlayof Z0by this j µday of�lldmL) 2001 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- tate of Florida) (Signature of Notary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 6160AH RUSSELL Commission No. q g�AH RUSSELL
• a ��, Notary Public-State of
Notary Public-State of FIor018 `-`•" =M Comm.Expires Nov Florida30,2018
'oP,F Commission#FF 179630 r" a Commission
Revised 07/15/2014 Bonded through National Notary Assn.
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Bonded through National Notary Assn. ����„����•
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