HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ��
RECER"T AUG 14-20 RECE
Building Permit Application AUG 12 2015
Planning and Development Services
Building and Code Regulation Division
2.300 Virginia Avenue,Fort Pierce FL 34982
Phone.: (772)462-1553 Fax:(772)462=1578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROUEM€NT,LOCATION,
Address: 1 �.}�i �- ¢'1�► V V
Legal Description: 4c„tkJ(A _ PC rg, V h11S
Property Tax ID#:ZA0 5A e C-)CX7—3 , Lot No. .
Site Plan Name: Block No.43
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION jNFORMATION:
Additional work to e e orme under this permit-check a a appy:
HVAC 'LGasTank FIGas Piping . Shutters Windows/Doors
11ElectricLil.Plumbing ❑Sprinklers [iGeneratgr Roof
Total Sq.Ft of Construction: -3 a!d So. Ft.of First Floor:
Cost of Construction:S �J44'31�— Utilities:0Sewer aseptic Building Height:
-OWNER/LESSEE:, CONTRACTOR:
Name 1u-rtc.. E3' . Name: THEODORE MANN
Address: I '
5_?5 t�)W ILA by l4���C * Company: AC MANN INC
City: Po d`-C 'c-r L;c-4%;" State:FL Address: 1050 SW BILTMORE STREET
Zip Code: Fax: City: PORT ST LUCIE State:FL
Phone No. Zip Code: 34983 Fax:
E-Mail: -"— Phone No, 772-340-4604
Fill in fee simple Title Holder on next page(if different E-Mail: pslacmann@aol.com
from the Owner listed above) State or County License: CACI 814425
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
,St1PPLEMENTAI CO;NSTRu,CTION LIEN LAW;INFQRMATION
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 df Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � �-CAO-Z2. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20by this l2�y of 20[IM by
"i�o�o�t� ��Ln lid �o�oc'e VY?G�nn
(Name of person acknowledging) (Name of person acknowledging)
t-L1JIl7�l k l �-'�> L
(Signature of Notary Public-State of Florida} (Signature of Notary Public-State of Florida)
Personally Known_L/"" OR Produced Identification Personally Known ice" OR Produced Identification
Type of Identifica io Pr,duced� _ . � >.*�� Type of identification
DEBORAH RUSSELL `a'aYn�a.,
Commission No. •moo�R�rba�% otary Pu( @al�late of Florida ,
Notary I' State of Florida
Commission No. - y�SuaS
; My Comm.Expires Nov 30,2018 c•, a My Com x res Nov 30,2018
Commission #FF 179630
1 + " sion #FF 179630
oc F`°`�� Bonded through National Not
Assn.
Revised 07/15/
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