HomeMy WebLinkAboutBuilding Permit Application ALL.APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED }
Date: Permit Number:
RECEIVED SEP.. Q-11
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)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Mechanical
PROPOSED_INPROVEMENT LOCATION
Address: ` r Jo
TQC
Legal Description - C-j= ^,zJ
PropertyTax ID#: t 3`g —7. 50 1 e C)09 C)CO -
Lot No.�
Site Plan Name: Block No.
Project Name
Setbacks Front Back:, Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
Aciditional work to De nerrormed under this perms —check all Inat apply:
✓HVAC Gas Tank alias Piping _.Shutters
aa Windows/Doors
11 Electric a Plumbing aSprinklers a Generator Roof
Total Sq. Ft of Construction: J S . Ft.of First Floor:
Cost of Construction:$ �-�- LCS• QC—) Utilitiescll Sewer OSeptic Building Height:.
OWNER/LESSEE . . CI ` f1e-r94
CONTRACTOR
Name &ACLName:. PATRICK FLETCHALL
Address: Lak-3 Company: COOL&RELIABLE AIR COND
City: i Pl State:FIL Address: 1051 NE SANTA CRUZ DR
Zip Code: �`1LJ� Fax: City: JENSEN BEACH State:FL
Phone No.�n S"Z�mp Zip Code: 34957 Fax:
E-Mail Phone No: 172-692-5750
Fill In fee simple Tide Holder on next page(if different E-Mail: rj_cooI@beIIsouth.net
from the Owner listed above) State or County License: CAC058567
If value of construction Is$2500 or more,a'RECORDED Notice of Commencement is required.
SUPPLEMENTAL`CON5T UCTtON LEN (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:
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.
. ,2
Sig'hifitiFe7of Owner/ ent/Lessee ature of Crntiiiry[ioigriisi�Holder
COUNTY OF STATE OF FLORIDA,+.LkC j � COUNTY OF STATE OF FIL AS i-`
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this�dayof Lc 20by this�dayof 20_Uby
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida (Signature of Notary Public-State of Florida)
Personally Knowna ,ro uce I {ffgtli�05SEi i ersonally Known tr' iCrfti�rodi eed—ld-entificalior,-.—, .�
Type ofldentification r a�' ffyPUMGStAG d pe of identification Produce ,KYA(��-,
poDEBORAH RUSSELL
otary Public-State of Flori
•; My CIomm Expires Nov 30,2018 : + -
Commission No. ? r • CD1fsion #FF 179630 mmission No. ° M{ 1)n.Expires Nov 30,2 B
' ` Bonded through National Notary Ass . �, Commission#FF 179630
' Bonded through Nationgi AIntpri AJ
Revised 07/15/2014
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