HomeMy WebLinkAboutBuilding Permit Application ALL APPUCABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date: Permit Number: HECEIVED
'� i� '• AUG 2 5 2015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division (
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)4624578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED IM,PRQVEMENT.LQCATIQN:
Address: i
Legal Description: 6 'q i fi t —Ag 'q V: 2Zi_,CWGr
Property Tax ID.#: (3' G`0-- It !' Col Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF WORK:
C'X'Ctd-- ref 1i-"fee4"C0+- 1 -T-o tJ G 94W-4t ie
.-TION.INFORMATION:
Additional worKto be oerformed under this perms –check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers 1:1Generator F I Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Sl OCA. Oct Utilities: Sewer Septic Building Height:
OWNER
n t-ES_S�EZ`�t��M`a� CONTRACTOR: .
Name I e_1L1 G � Name: CRAIG CANTRELL
Address.i�9l�� S'�a7 lr '"' P" Company: + TEK AIR CONDITIONING
City: Jz(A63 State:FL Address: 571 MERCANTILE PL#,B-12
Zip Code: I v' ' Fax: City:, PORT ST.LUCIE State:FL
Phone No. Zip Code: 34986 Fax:
E-Mail: Phone No. 772-801-3465
Fill in fee simple Title Holder on next page(If different E-Mail:.amtekac@gmaii.com
from the Owner listed above) State or County License: cac1816639
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEIU IAW, INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEESIMPLE 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 theissuance 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.
Signatur of Owner/Agent/Lessee Signature of C ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF "S±. Lrt<Pa-e COUNTY OF S:E L-LtCA e,
The forgoing instrument was acknowled ed before me The forgoing instrument-was acknowledged before me
th's , e1bby of ��20US by thia2uay of G' 20®by
(Name of pers cknowledging) (Name of person acknowledging)
��mt I lv�-:RW46a_ ..
(Signature of Notary Public-State of Florida) (Signature of Notary
y Public-State of Florida)
Personally Known V/ OR Produced Identification Personally Known "' OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. vnea
'�� g699I)AH RUSSELL - Commission No. S
,��s Notary Public-State of Florida ,,.� ���� t EBORAH RUSSELL
*� ;o? Notary Public-State of Flori
•: :•E
My Comm.Ex dres Nov 30,2018 ,•, ,
OF F���O`` Commission#FF 179630 , %�, o Commission#FF 179630
Revised 07/15/2 4�� Bonded through NationEX
al Notary Assn.` 9;;;
Bonded through National Notary Aall y 191- s
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DATE
RECEIVED
DATE
COMPLETED