HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE=IN MST BE CQIL'RPLETED FOR APPLICATION TO BE ACCEPTEIJ ) ['
Date: 8/3Q/15 � I I 0 SIJ
Permrt Number. i's
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Building Permit Application
Planning and Development Services
,Building and Code Regulation Division
2300 VIrginla Avenue,Farr Pierce FL 349$2
Phone: (772)462-2553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5304 PALED PINES CIR
Legal Description: HOLIDAY PINES
Property Tax ID#: 1312-801-0085-000-9 Lot No 282
Site Plan Name: ROSEMARIE ORTIZ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALL CARRIER 31/2 TON 14 SEER SYSTEM WITH 10 KW
CA14NA042 / FB4CNF042 LIKE FOR LIKE
CONSTRUCTION INFORMATION:
Additional work o11asTank
orme -under this permit–check a app y.
HVAC ❑Gas PipingShutters EIWindows/Doors
11Electric 0Plumbing Sprinklers E_Generator Roof
Total Sq.Ft of Construction: SFt.of First Floor;
Cost of Construction:$4360 _ Utilities: Sewer septic Building Height:
OWNER/LESSEI=: CONTRACTOR:
NameROSEMARIE ORTIZ Name: MARK BLACKWELL
Address:5304 PALEO DINES CIR Company: BLACKWELL&SONS AIC
City. FT PIERCE State:FL Address: 317 ST LUCIE LN
Zip Code:34950 Fax: City: FT PIERCE — State:FL
Phone No. Zip Code: 34846 Fax:
E-Mail:_.. Phone No. 772-461-1000
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License, 1816791
If value of construction is$2500 or more,a RECORDED Notice of commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERTENGINCE—R. 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:
Addre.5s, Address:
City. City;
Zip: Phone- Zip; Phone:
I certify that no work or installation has commenced prior to the Issuance of a permit.
St.LucleCoun 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 130ding 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 fallure 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 tender or an attorney before
cornmenciniz work or recording your Notice of Commencement.
Signature of Owner/Lessee/Agent Signa re&'Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF —
The forgoing Instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this-10 day of Rod 20 !L 7 this 30 day ofA(A .20 ,4_by
MCIA Lvaal4k Mort - f3ladw 11
JN c atacKnowleding) (Name of perso n wledgi
rsonictnowledgl
(Sig *�- f of ry Yp a a (Signa Lire of Not e 0 0
'TRAKAY LA14GEL
48072
A. 1AWAS%0�&F1 persor I'
Personally Known P cation
Type of tdentification EXPIFIE5 ALugust;4VV, TYPE! itfer fl6a 1cm 148072
FJnr1daN010;VS61u1r6,c0T p- eXPIRESAU 30,10113
Commission No. (01) (Seal) Comm colse
Revised 07/15/2014
REVIEW5 FRONT ZONING SUPERV150R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
C MPLETE
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