HomeMy WebLinkAboutBuilding Permit Application Al
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d¢
Date: G` 3— /S Permit Number:
� Qa'M JUN 2 3 ZQb
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
PRQPOSED{IN`PROVEiVLENT LO.CATIQ;N . .
Sos5 Al. 11/A
Address: IV
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Legal Description:�n y/I/ /"1Q'ii►�iQ �Cc'd1V 7, S UA-17- OY
Property Tax ID#:, _('O/ — ON? Lot No.
Site Plan Name: Block No.
Project Name: 5011k,
Setbacks Front Back: Right Side: Left Side:
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DETAILED DES'CRIPTION.=OFWORK
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A/C CHANGE OUT EXACT REPLACEMENT
CONSl"RUCTiON INFORMATION: "{
Additional work to Be Koefformed
, under this permit—c eckall appy:
ZHVAC Gas Tank ElGas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers FIGenerator Roof
Total Sq. Ft of Construction: S .Ft.of First Floor: 4� /
Cost of Construction:$ 3611Utilities: _Sewer F]Septic Building Height:.
0111/NER/L"ESSEE: "` ". CONTRA(TOR:
Name !C ic' // Name: MARKAVINES
Address: 5-05"5 /)/ X44 A fOY Company: AZTIL
City: `'/ /E/�CE" State:F� Address: 2540 S MILITARY TRAIL
Zip Code: 3'I9 I/9 Fax: City: WEST PALM BEACH State:FL
Phone No. Y07) 1�2 9 — T-909 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: Pk-&l eQzr6e dL.Cohn
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.
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S�UP'PLEMENTALCONSTRU"CTION 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 recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF /fSZ'- COUNTY OF PALM BEACH COUNTY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this a3 day of r)ry✓-- 20by this ;6 day of 36(n.r 20®by
A1114 X.
(Name of person acknowledging) (N of person acknowledging)
SiErn!at of No ublic-State of Florida) (Signatur f otary Public-State of Florida)
Pe sonally Known _OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
e" JOHN ED�M -GIFFORD
°" ' `°" Commission No. _°•'` 4'`�':
Commission No. ==r 4': JOHN E[�� RD GIFFORD 1 € Y coMM�SS ON�#FF0774z7
MY COMMISSION#FF077427 °P
EXPIRES December 17,2017
cem er 17,2017 (407)398.0153 FloridallotaryService.com
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(40798-0153Florida NotaryServiCe.COrn
Revised 07/15/
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