HomeMy WebLinkAboutBuilding Permit Application e'
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01 5 Permit Number:
914.0
=� ry RECEIV D AUG 0 61015
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 v CSC
PROPOSED_IN'PROVEiMEiNT LOCATION: -
Address: 333 /�IZlZ
Legal Description: d/7C��'G,�� � S Mill►7-i-
Property Tax ID#: 5-000 000- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION',OFWORK:
A/C CHANGE OUT EXACT REPLACEMENT z1
10
CONSTRUCTION-INFORMATION:
Additional work to be pertormed under this permit-check all h appy:
ZHVAC Gas Tank ing _ QWindows/Doors
❑Gas Pi Shutters
Electric ❑ Plumbing Sprinklers Generator Q Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
pp �� I- c9-:7
Cost of Construction:$ W CJ S� Utilities: Sewer F]Septic Building Height:
OWNER/LES-SEE: CONTRACTOR:
Name 6771 �S4l�1Z Name: MARKAVINES
Address: 333 ,jE�1�IOl�S'� �f? c�-Gv Company: AZTIL
City: li?r/7 JV/' z_ G1r_ State:FL Address: 2540 S MILITARY TRAIL
Zip Code: 5Y9Y-;2 Fax: City: WEST PALM BEACH State:FL
Phone No. (7;w 377.9_600 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.
SUPPLEMENTAL CONSTRUCTION l IEN LAW.I,NFORMATIO;N {
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 thepermit 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
COUNTY OF 9M COUNTY OFPALM BEACH COUNTY
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this K day of Ads 20n by this 6 day of At-, 20=� by
(Name of person acknowled 'ng) (Name of person acknowled ing)
at
p�..
JOHN EDWARD GIFFORD
o, ate: JO, N ED AR GIFF R
Per auy r I catio Pe on a *��n r `'�i,�v��Q �g �� +� tion
pe fYtip�1�ppr1-9 e Type d` 6n&Ism
OF F4.... . O
4a7 9 153 FlorldallotaryServlce.c (407)398-0153 FlorldallotaryServlce.o
Com CommissI
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED