HomeMy WebLinkAboutBuilding Permit Application Sep 15 15 07:48a Grossmann Air Conditionin 772-3989727 p.2
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` a
Date: `1 1 SI Permit Number: 15� l- day a
RECEI°._D SEP.15 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)462-1578 Commercial Residential IV/
PERMIT APPLICATION FOR: To Select from Iropbox, click arrow at the end of tine 0 1 (x L
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PROPOSED IMPROVEIVIENTLOO)CATION. ...... ::::.::...: •.: :. ... .
Address: ""f o i✓S ��,K 1 r'? // T-e
Legal Description:
Property Tax ID#t: X 322�C�-3- /7;- �G Lot No- l lA --
site Plan Name: Block No.
Project Name:
Setbacks Front Back: �� RightSide: Left Side:
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na wos to e ertormeci un er t is permit—c ec 'I"
app V'
_HVAC Gas Tank ❑Gas Piping Shutters WindovsrsfDoors
Electric Plumbing 05prinklers M Generator FIRoof
Total Sq. Ft of Construction: �I Sq.Ft.of First Floor:
Cost of Construction:$ (� �. Utilities: Sewer DSeptic Building Height:
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Name raeLe_ 3'�X LSl'?�C<,� ----- - Name: - -Fe-- �L'�tS�b'Yt i
Address: :!L� �J_.__.( �� �____�Cr�` �—I�_ Companv:(-_"f fSS YYI/tl� ►r= l���Lli®'b14i?��
City: ��V><s . 1LC�1 stater Address: ID223 E� Let-v-em-cd � 1 - --
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Zip Code: Fax: City: OVf C t e. State:�L
Phone No. -7-7 2 -3�1' '9?ZS Zip Code: 3 Fax: 72--S-1'F-D2?
E-Mail: Phone No. ~]72 2-2 2-5-
Fill in fee simple Title Holder on next page{if different E-Mail: Gil-95$�517'tiCl-17t1
from the Owner listed above) State or County License: rJ9 15 02 9
If value of construction is$2SOO or more,a RECORDED Notice of commencement is required.
Sop 15 15 07:48a 8moomonn Air Conddionin 772-3089727 p.3
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N FORM.
DESIGNER/ENGINEER: Not Applicable i MORTGAGE COMPANY: Not Applicable
Na me: Name:
Address- Addr,-ss-
City: State: City: State,
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER. NotApplicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City; City:
Zip: Phone: Zip: Phone:
I certifV that no work or installatiort has commeaced prior to-the issuance of a permit.
St.Lucie 1--our"I makes no representation that is granting a permit will authorize the 9 ermit holder to buncr the subjea structure
which is in c" lict with any applicable Horne owners Association rules,bylaws or an 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 Suilding Codes and St-Lucie County Amendments.
The following builcling permit applications are exempt from L�'nclergoing a full concurrency review.-room additions,
accessory structures,swimming pools,fiences,walls,signs,s leen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Ri ti e of Commencement may result in your paying twice for
improvements to your property,A Noth Iti encement must be recorded and posted on the jobsite
before the first inspection. Ifwu intend to obtain financing, consult with lender or an attorney before
Signa Sig
STA ORIDA ST
Co
The forgoing instrupent was acknowledged before me The forgoing instrument was acknowledged before me
(Signature of P66lic-StateDf Florida (signature of Notar-7/Plublic-State of Florida I
Per5onallyKnown c--' OR Produced identification PersonallyKnown v��' OR Produced Identirficat Ion
Type of Identification Produced Type of identification Produced
(seal) Commission No
Gail H_ Gentle Gall K Genge
AP�7CWIIJMM I EE 083M
Revised 07/15/2014 'P OF fV11P mWAAW-MTAW.Gon WWWAAF0%4DTAF%Yz0M
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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