HomeMy WebLinkAboutBuilding Permit Application Aug 25 15 09:07a Grossmann Air Conditionin 772-3989727 p.2
ALL APPLICABLE INFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 10
Date:$ as v5 Permit Number: 5 O�
RECEIV701 AUG 2 5 2015
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Building Permit Application
Planning and Davelopmen[Services
Building and Code Reguiafian 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 arrow at the end of line
PROPOSED IM PROVE MENTLOCATION..
Address:
Legal Description:i11 c,-1l me-Sea W I fT 4
Property Tax IV It: �U� G -�Y%D1G' 0,0, --' _ Lot No.
Site Plan Name: Block No.
Project Name: e�Ctl'1L Y i C
Setbacks Front Back: Right Side: Left Side:
DETAILED-f3ESCRIPTS0114-01=.i111`ORK, ..
PC Cftafllecce� -l-r' f, `� 1(,k-L-
CONSTRUCTION IN.FORMATI.ON:
Adclitio,aa wor toe e orme un erthis permit-check afn5hutters
apply:
_HVAC Gas Tank ❑Gas Piping Windows/Doors
ElElectric U Plumbing Sprinklers Generator E]Roof
Total Sq. Ft of Construction: SQ. Ft.of First Floor:
Cost of Construction:$ f�00,`N Utilities: 1 ;E Sewer Septic Building Height:
!OWNER/LESSEE:.--
.... ... ..: ,, . ... ... : .-.;. .CONTRACTOR:
Marne GU 1 C Vi G Name. - m—s Lnn
Address: OOZE S. OC.etIFl DY; '�"1�L� Company t 0-6-
019
City: �F'1 '��. State: f� Addr s: l '
Zip Code: 3L- LI_S`7 Fax: ��f - `�2-� Cit 1��� State:
Phone No. �?Q QI "-`"i7 25 Zip ode: Fax: �J?Z-- 7
£-Mail: QG�%SS�Y)Qf�i7C/teirnCa,S- oe7` Pho e No. �'
Fill in fee simple Title Holder on next page I if different E-Mail: 055i..71tu if-)CECfCO co ICCes
from the Owner listed above) State or County License:
If value of construction is$2540 or more,a RECORDED Notice of Comrr encement is required.
Aug 25 15 09:07a Grossmann Air Conditionin 772-3989727 p.3
SUPPLENIENTAL.CONSTRUCTkO,N LIEN (.AW INFORMATION:
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:
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 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 Natice c f 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 u intend to obtain financing,consult with lender or an attomey before
commencin WQfk or reco_ your Notice of Commencement. ,
.
/Of ! .L" -tom, I X
_Si4gna Iner/ ssee/Agent Y'is��i�,.i,,,; j Signatur, �EC0 racbArAiC hse Holder
i STORIDA STF LORfDA
COOF `!; _/.i C/ COU�V OF �f �1:C.;�,•
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this2day of AL qL-('S'4- ZO I�LcS+ _20 l�by
lar..� lE'
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pt blic-Stateof Florida) I (Signlature of Ndiai�Public-State of Florida)
Personally Known ✓ OR Produced Identification Persdnally Known �� OR Produced Identification
Type of Identification Produced Type of Identification Produced —
Commission No. f��'u!%L.3 (Seal) Commission No.k G� tet' �� (Seat)
Gaii H. Gentle Gail H. Gentle
na r�nC a;�rRY aC•��'y'� 1
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