HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEP-T-EO
Cate- Permit Number- 1� � �\� Z
Building Permit Application AUG 1 1 2015
P/onning and Development Services
Buz/ding and Code Regulotion Division PERlJ11-'+'r'"
2300 Virginio Avenue,Fort Pierce FL 34982 S[_Lucia C.c�=��-`:'
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR= MecFianical
PROPOSED INPROVEMENT LOCATION:
Address- O -
Legal Cescription:
Property Tax IC#:��i n l0 �� o =3r_ 7Ang-->-75 Lot No. �.
Site Plan Name-_ Block No-
Project Name: VA-/ C- tom
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AA--,
CONSTRUCTION INFORMATION:
�tiona wor oorme un ar is perms -c ec a apply:
✓=HVAC Gas Tank =C-'as Piping _Shutters Q'�l Windows/Coors
Electric 0 Plumbing =Sprinklers Generator =Roof
Total Sq. Ft of Construction: S r�-05 5 Ft_of FirstFl-"�-lr:
Cost of Construction:$ G3C>- Utilities- Sewer LFl�J Septic Building Height:
OW N ER/LESSEE: CONTRACTOR:
Name Name- COUGLAS PENCE
Address- 3 - `G Company- ABSOLUTELY COOL AIR CONCITIONING
City: State:FL Address: 231 1 NE 15TH COURT
zip Code: t-7rl L`$ �_ Fax: City: JENSEN BEACH State:FL
Phone No- Zip Code- 34957 Fax-
E-Mail- _ Phone No_ 772-475-4641
Fill in fee simple Tile Holder on next page(if different E-Mail: absolutelycoolair�gmail.com
from the Owner fisted above) State or County License: CAC1815702
if value of conseruCtion is$2500 or more,a RECORUEU Notice of Commencement is required_
DESIGNER ENGINEER: _Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
?i P: 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 Horne 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 r paying twice for
improvements to your prytyo��
Notice of Commencement must be recorded d po d on the jobsite
before the first inspe n. If ntend to obtain financing, consul "th lenderor an a rney before
comm wor or ecordiur Notice of Commencement.
,Z�ii
Signature q4caner/Agent/Lessee knkure of /n_tractor/Li-centi Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF (.J ,c`E'— COUNTY OF tA lte
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this t&Nay of 20by this 16�fiay of 20&�by
(Name of per cknowledging) (Name of pe4n acknowledging)
L- I
(Signature of Notary Public tate of Florida (Signature of Notary Public-State of Florida)
Personally Known .1/ OR Produced identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. "";"''�, (SARAH RUSSELL Commission o. nFBORAH Rt(S@�1k
Notary Public-State of Florida 'o` ��I�e
;•_„ ,o% Notary Public-State of Florida
' = Nov 30,2018
N9l�Il"„°Q,��• Commission #FF 179630 '�; °F"`•o`= commission#FF 179630
Revised 07/15/20 °F F`"' Bonded throw h National Notary A>;n °p•••
9 Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED