HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
1,} C j�Inl AT Permit.Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
23010 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(172)462-1578 Commercial Residential X1
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPRQVE.MENT LOCATION:_ nn
Address: 1 !5 U> LA:)0$T (50�4
Legal Description: e ®Uig R(ck2ig PuT a
Property Tax ID#:.44a 6 _ 503- cc>Aci - Lot No.
Site Plan Name: Block No.
Project Name: � 'ZQ. "�
Setbacks Front Back: Right Side: Left Side:
D.ETAII.ED DESCRIPTIOUCIF'WORK:
Lei X4c;x :�t�mm� r'C' CS F - c)" 1 5 ..
CONSTRUCTION;INFORMATION
Add
Etlona wor to .eve orme un er t ss permit—c ec a e apply:
HVAC F
��.JGas Tank F]Gas Piping Shutters Q Windows/Doors
11 Electric M Plumbing Sprinklers 0 Generator >...1 Roof
Total Sq.Ft of Construction.4Q5C'::�--7. SQ.Ft.of First Floor:
Cost of Construction:$'A Utilities:mSewer Septic Building Height:OWNER/LESSEE:.-CONTRACTOR::
NameName: THEODORE MANN
Address: kf!> t4LZ� 'SgM±e Lf- Company: AC MANN INC
City:OALAA State:FL Address: 1050 SW BILTMORE STREET
Zip Code _991012 Fax: City: PORT ST LUCIE State:FL
Phone No..^� 4(Q0 S7: Zip Code: 34983 Fax:
E-Mail: Phone No. 772-3404604
Fill in fee simple Title Holder on next page(if different E-Mail: pslacmann@aol.com I
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.
SUPPLEMENTAL CONSTRUCTION UEN LAW INFORMATLON
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
.FEE SIMPLE TITLEHOLDER: _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 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.
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Signature df Owner/Agent/Lessee Signature of Contractor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA o N
COUNTY OF '57 _ L.19G2 b COUNTY OF J LLco
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The orgoing Inst ument was acknowled ed before me The forgoing instr ment was acknowledged before m cc �„
thiS6O day of VG0W1 20 -,Vby this 2.Qday of 20!(�by < C3. =
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(Name otperson acknowledgin (Name of person acknowl ging a
��G urn bOiy
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Pr duced Identi ication Personally Known�`OR Produced Identification
Type of Identification Produced ntification Produced
o1P"r°�e�•.� SHAWN A RUSSELL
0 G� ,'�' '"_ �,.5-09� Seal
Commission No. C�0-7 .« J� Notary Public-Sta eCObiilRfiid�s n No.1,15-09L. ) -
:N My Comm.Expires Alar 11,2016
,�i�FOF F�gr� Commission#E 178096
Revised 09/15/2014
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