HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ct 1 i Permit Number: , • yZ2V
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
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVEMENT LOCATION. .
Address: 4,5qO ' L r,�
-� c
Legal Description: . �Je -�
Property Tax ID#: 3`f0"') Lot No.
Site Plan Name: Block No. 01 n
Project Name: Pf"o
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION:
Additionalwork toe Dertormed, under this permit-check a appy:
HVAC Gas Tank []Gas Piping _Shutters E]Windows/Doors
11 Electric 0 Plumbing F-ISprinklers F]Generator Roof
Total Sq.Ft of Construction: '1 31,0 Sq. Ft.of First Floor:
Cost of Construction:$ C`X7.ar� Utilities:o Sewer Septic Building Height:
0wNER/LESSEE CONTRACTOR
Name O \\ -(� Name: MICHAEL EWING
Address:c22L4 a 01 ��'n �iIL Company: PIONEER COOLING&HEATING
City: (' State:FL Address: 585 NW MERCANTILE PLACE# 106
Zip Code: 5 � Fax: City: PORT ST LUCIE State:FL
Phone No. �26,4 -�"i -��j Zip Code: 34986 Fax:
E-Mail: Phone No. 772-579-9209
Fill in fee simple Title Holder on next page(if different E-Mail: pioneerheatingco@bellsouth.net
from the Owner listed above) State or County License: CAC1817251
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SIfPRLEMENTAL CONSTRUCTl0�1 LIEN 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 holderto 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.
LAC �
Signature of Owner/ ent/Lessee ignature of Contract Li ense Holder
STATE OF FL A STATE OF FLORID
COUNTY OF l ,c,e COUNTY OF '--4— �—
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this d'ay of PO�C'm�?P�.204 by this�481ay of . 20Mby
(Name of person acknowledgin (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known d4denti#icptL Personally Known y OR Produced Identification
Type of Identificatio Prp $' DEBORAHType of Identification Produced.
Notary Public-State of Florida ;
s Commission No. .s;RY'd��,, DFIId RUSSELL
Commission No. '- i + My Corr(�eetcpires Nov 30,2018 ;a . °: Notary ublic State of Florida
=;9rFr111,p��� Commission#FF 179630 =• w• My Comm.Expires Nov 30,2018
Bonded throw
Qh National Ninhn,A— - Commisg
° Bonded through National Notary Assn.
Revised 07/15/2014 e v
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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