HomeMy WebLinkAboutBuilding Permit Application Sep 10 16 05:26p Grossmann Air Conditionin 772-3989727 p.3
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:\ Permit Number:Se
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34992
Phone:(772)462-1553 Fax: (772)462-1S78 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line V atC.
PROPOSED IMPROVE MENTLOCAT- 10 .: -- f
Address: 3I C;.5 ` cco_i- l e+ Ibis Lar,
Legal Description: 00<'g ���� CL}- Ct- `'Ja Vczn n6j C.(L,,L_b
Property Tax 10 if: ?D-4o- -goI -'Q O I P �0CG_- Lot No. �17_ �
Site Plan Name: Block No. �3
Project Name: �JcI)iPg 4 CeA he.rinc cSL
Setbacks Front Back: Right Side: Left Side:
DETAILED;€3ESCRIPTLOK.QF.WORK:.. . ..
CONSTRUCTIO NJNFOR.MATI O N: :.
MiHVAC
na wor to e e orme un er t is permit-c ec a }appy:
F Gas Tank E]Gas Piping i Shutters ❑Windows/Doors
[lectric 0 Plumbing Sprinklers _Generator a Roof
Total Sq_ Ft of Construction: `1 ft 5F _of First Floor:
Cost of Construction:$ -1� '1 y- Utilitiest Sewer 0 Septic Building Height:
QVIlNER1LESS>:E:
r Height-
CONTRACTOR:
Name_ l 1� 'f CC1.�"d�eri'n_ -.L!f 11hr4n Name:
Address:. 'S Z ?� Companyb4�'('�S'--I'Y1CL41* RK igJ[* iJYlt0 "
i City: '' 5 •Uta P
--� State:_F2, Address: E C 223 cg�>
Zip Code:'3 Fax: �� Cit 4 State: R,
Phone No. �`L7 7 Sr � 1 " � Zip ode:� �5'?_ Fax_
E-Mail:�!rY� 4rVIC�Y11'1 C1C �t1 r CaS?,nt?' Ph e ZS
Fill in fee simple Title Holder on next page(if different E- ail: j ,.SS'Y IZ2::�a
from the Owner listed above) Stale or County License:
If value of construction is$2500 or more,a RECORDED Notice ofComniencementis required_
Sep 10 15 05:26p Grossmann Air Conditionin 772-3989727 p.4
SUPPLEMENTAL CONSTRUCTION LIEN 'LAIN I.INFORMATjO N:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: , Not Applicable
i
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 apermit 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 db hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building(odes 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- IfNou intend to obtain financing, consult:with lender or an attomey before
commencing k or recqWg your Notice o_f_Commencement.
Signa er/ ssee/Agent Signatur E'Co ractoi/lic nse Holder
j�.
STA ORIDA ST �F LORIDA
CO ' OF �� L-�C.°/t: COUN OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 D�`'day of 20 l5 by this�1"day of -- is n 1-20 by
(Name of person acknowledging) (Name of person acknowledging)
C j!
(Signature of Notary P lic-State of Florida) I (Signature of NdtaryPublic-State of Florida)
i
Personalty Known ✓ OR Produced Identification Persdnally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced _
Commission No. (seal) Commission No- J-5 Z? (Seat
1..... Gaii H. Gentle �;��";�_-s Gall H. Gentle
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wire :JAN.15,2018 :.IAN t5,2D18
Revised 07/1.512014 '.?
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REVIEWS FRONT ZONING SUPERVISOR PLAI(15 VEGETATION 5EATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIRW REVIEW REVIEW REVIEW
DATE --T--
COMPLETE
INITIALS