HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTEi? ,cc
Date: `� 5 . Permit Number.: SC
R'ECEI I'
Building Permit Application -:D AUG
Planning and OeveiopmencSe►vices
Building and Code Regulation Division
2300 Virginia Avenue,.Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 COmmerciai._ Residential
PERMIT APPLICATION FOR,* Mechanical L a
"P.R-bPOSED INP�QVEMENT LOCATION
Address: L P V
Legal Description: ',e— L "
Property Tax 10#: -� C� .. — � Lot No.
Site Plan Name: Block No.
Project Name: d6 ,24�g1�'
Setbacks Front Back: Right Side: Left Sider
;NTAILED DESCRIR:TIUfiI OF W,URI{
CONSTRU- IONINFORMA_ TI(3N .
Additional Work to-be erformed 'under t is,permit—a ee 'a appy:
1-71
JXJHVAC Gas Tank FIGas Piping _Shutters Windows/Doors
Electric 0 Plumbing ❑Sprinklers 1i Generator F-1-Roof
Total Sq.Ft of Construction: `lam _ S Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer
F—Septic Building Height:
OWNER/LE55EE .. CONTRAC 'IJR.
NameName: THEODORE.MANIJ
Address:`e- L L t '0r >I Company:.AC.MANN INC
City: ``r+- Ea Li ' ',, State:F� Address: f 060 SW BILTMOFtE,STREET
Zip Code:5grj5�;kFax.: City.. PORT ST LUCIE State:FL
Phone NOr,-":y-":y6
o. a �32 '(—I % Zip Code:: 34983 Fax:
E-Mail: Phone No. 77.2-3404604
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: CAC1814425
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUFPLEMEtVTAL CONSTRUCTION L1ENy LAW INFORMATION
m
,DESIGNER/ENGINE.ER' _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 COMPANYc _Not Applicable
Name•.. -- Name:
Address: Address:
City: . City:
Zip: Phone: Zip:T 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 issuanceof a permit-
St.Luci 'Count yy..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 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 approvedplans,the Florida.Building Codes and St:Lucie County Amendments:.
The following building'permit applicationsare 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 workorrecording your Notice of Commencement.
i
Signature of-Owner/Agent/Lessee Slgnature"of Contractor/License.Holder -
STATE OF FLORID!, f STATE OF FLORID.
COUNTY OF - L1�('_t -P_ COUNTY OF Lit <A
The.forgoing.instru lent was acknowledged before me The for� ng instru ent was acknowledged before me
this qday of i t G i.� 20�by this '—}day of �+- • ' ZO— by
(Name of person acknowledging) (Name of person acknowledging.)
' 4
(Signature of Notary Public-State of Florida) (Signature of Notary.Public-State of Florida)
Personally Known Jto�_OR Produced Identification Personally Known. V OR Produced Identification
Type of Identification Produced Type of Identification Pr d ce
�� , EB AH RUSSELL
Commission No. ..sra �8,,, ( RAH RUSSELL Commission No. ef�; Notaf��tl�lic-State of Florida'
Notary Public,-State of Florida = ; ;• My Comm.Expires Nov 30,20113
E My Comm.Expires Nov 30,2018
ommission#FF 179630 °;'
Bonded through National Notary Assn:
Revised 07/1512014r.��"""• Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
[!ATE OMPLETED