HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: $_ _\5 Permit Number: 5
RECEI'.' I AUG,11 2015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
°
PERMIT APPLICATION FOR: To Select from dropbox, click here aL
PR+OPOSFD'INPROVEME.iUT LOCATION .- ,
Address: ��®� (! ACA3kpPeir 912
Legal Description: 54 i//Jr✓�/�� 610,6 fY4% ;IVj4 Cr ;WZM-_ 131,,e�02 L07_/v�
Property Tax ID#: s,® Lot No./—Z
Site Plan Name: AfI'K Block No.y'_',
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED Dij"ESCRIPTION D-F WORK;
A/C CHANGE OUT EXACT REPLACEMENT �v fits j�.s
I LI ) S Id A(ty /E Mid,4o�JkOOQ
CO NSTRUCTION..i N FORMATION
Additional work to e—e orme under this permit—check a _ff rSh
y:
❑HVAC be
Gas Piping tte
rs ❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ W7
Utilities:11_Sewer O Septic Building Height:
OiNNER/LESSEE:. CONTRACTOR:.
Name s8/✓ i3ie - Name: MARKAVINES.
Address:F%GDO 6AO8,rb h- A Company: AZTIL
City:_/ /Z7- ;'i, g�uLlk State:FL Address: 2540 S MILITARY TRAIL
Zip Code: 3VOJ:c2 Fax: City: WEST PALM BEACH State:FL
Phone No. (77.12 13�-- fY(15 Zip Code: 33415 Fax: 561-434-0018
E-Mail: Phone No. 561-433-2197
Fall 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.
r
;SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORM,AT ON
~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.
z'/'�
Signat re of wner/Agent/Lessee. Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF- �1 A g�Gi/ C.�osc4Li CO U NTY 0 F PALM BEACH COUNTY
7
The forgoing instrum nt was acknowled ed before me The forgoing instrum nt was acknowledged before me
this L_day of 41t, 20 ]S by this i day of i•i 20 FM by
(Name of person a knowle (Name of person acknowledging)
igna r o o ry Public-State of Florida) (Signa e o ry Pub' tate of Florida)
IFF RD Perso II
Per onally Known = , 4 d�iN� #RQP y Known"" "Pr �lld ifil�t rFORD
Type of Identification od g° MY COMMISSION#FFo77427 Type of Identificatio .,pce�= MY COMMISSION#FF0774 7
o "ani` EXPIRES December 17,2017 "o J EXPIRES December 17,2017
.;F kti,n
Commission No. (4Q?)9®�-q1�� FI Rt81 taryservlce.com Commission No. (407)39a•o163 Florida 45Paaervice.corn
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED