HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: August 4, 2015 Permit Number 150- 'WQ 5 3
RECEIVED AUG 04-2015
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: Other ao-
Address: 135 PEPPER LANE JENSEN BEACH FLORIDA 34957
Legal Description: BAY TREE LOT 8(OR 3652-825)
-4511- 503- poly- 600 -Co
Property Tax I D#: Lot No.8
Site Plan Name: PEPPER LANE Block No. 3652
Project Name:
Setbacks Front ._.. .....__.._.__.__ Back: Right Side: Left Side:
MIMI
AC CHANGE OUT- 3 112 TON, 14 SEER, 8KW
Additional wor to De oertormed unclert1iis perms -c ec a app
Y.
[]HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing 0Sprinklers 01 Generator 0 Roof
Total Sq. Ft of Construction: . _ ScFt.of First Floor:
Cost of Construction:$ 2475-00 Utilities: Sewer Septic Building Height:
NameRONNIE DIBARTOLOMEO Name: DEREK POWELL
Address:PO BOX 408 Company. AIRONE COOLING AND HEATING LLC.
City: MONTEREY State:CA Address: 340 SW PAAR DRIVE
Zip Code: 93942 Fax: City: PORT SAINT LUCIE State:FL
Phone No.561-729-1471 Zip Code: 34953 Fax. 772-878-5711
E-Mail: Phone No. 772$78-5711
Fill in fee simple Title Holder on next page(if different E-Mail: AIRONI=COOLING@YAHOO.COM
from the Owner listed above) State or County License: CAC1817926
If value of construction is$2500 or more,2 RECORDED Notice of Commencement is required.
0
12
DESIGNER/ENGINEER: T 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 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 rule's,bylaws or and covenants that may,restrict or prohibit such
structure.Please consult with your Home Owners Association and raview 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
commencingwork or recording our Notice of Commencement.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY 0F COUNTY OF STLUCIE
The fQ r�oing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this 3 day of 20 y this a day of A"r-' T ,20 _L5by
1 DEREK POWELL
(Name of person acknowledging) (Name of person acknowledging)
(AAny &Eftmaw4 - aounlia
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Shy r'
Personally Known ' " E>R � �� .MA. Personally Known OR Produced Identification
Type of Identificat :;Ay, comwsstQt�;�,',:F,902190 Type of Identification Pr
RES J "Ytij AwEtt M TRANIE".
Commission No. AU`Y 0753 Commission No. My CON469*14*FF9=180
E,
EXP.IRU July 24,.2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS