HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO-MLIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s 1r� Permit Number:
REGI
Building Permit Application AUG 2 5 2015
Planning and Development Services
Building and Code Regulation Division
23010 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)46271578. Commercial Residential
PERMIT APPLICATION FM Mechanical
PRfJPOSEDIIN'PRtJVEMENT.LOCAT#QN:
Address,
,222 1h1 vS
Legal Description: n I Q
Property Tax ID#: L#42 to Sb, 15 Q0 IoR 000 Lot Na,
Site Plan Name: Block iso.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA#LED DESCR#PTIQNOF 1NC},RK
CNSTRUCTIQN #NFORMAT#ON
Additional wor toe e Orme 'under this permit—c ec a a appy:
HVAC F Gas Tank ❑Gas Piping . Shutters ❑Windows/Doors
Electric !Plumbing ❑Sprinklers 11 Generator O Roof
Total Sq.Ft of Construction: I rsis U . Scl.Ft.of First Floor:
Cost of Construction:$ -14 cl Oo.t>[> Utilities: Sewer Septic Building Height:
-OWNER/LES,SEE'
CONTRACTOR: _
Name MoAr
ce—
Name: THEODORE MANN
Address: ti? company:.AC MANN INC
City: e �s P State: 1 Address: 1050 SW BILTMORE STREET
Zip Code: Gt[e8 Fax: City:. PORT ST LUCIE State:FL
Phone-No. n'V- _340-4U04 Zip Code: 34983 Fax:
E-Mail: - Phone No. 772-340-4604
Fill in fee simple Title Holder on next page If different E-Mail: psiacmann@aol.com
from the Owner listed above) State or County License: CAC1:814425
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEIVIENTAL�CONSTRUCTION LIEN4:LAW.':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:
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.
Signature df Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF LaCc'�e, COUNTY OF Si Lu e-c e
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
thi lay of 20U.S by this 'qday of 20[0 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally KnownOR Produced Identification Personally KnownOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (fKBORAH RUSSELL Commission No.
"""'�� DEBORAH RUSSELL
Notary Public State of Florida �taR Mm "�a'.,
* _ RAY rn
s Nov 30,2018 ;s, 4 6S Notary Public-State of Flori
=�.* - °o;� Commission #FF 179630 _-. .•_My Comm.Expires Nov 30,2013
Revised 07/15/20 ' '%,F��F����� Bonded through National Notary Assn.j' 9F Commission#FF 179630
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Bonded through National Notary As
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
-COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED