HomeMy WebLinkAboutBuilding Permit Application f i
ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: �rd I' lc�r Permit Number:
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: To Select from dropbox, click here
PROPOSED IiVPROVEUIENT�LIOCAT#ONS:;
Address: (Du�? �eXr�I
Legal.Description: aim Aroye?
Property Tax ID#: 3g1Q 503' 05/ ' ' 000 ` 7 Lot No. ' /,.
Site Plan Name: Block No.
Project Name: oL USGhcr, � ne—
Setbacks Front Back: Right Side: Left Side:
DETAILED DE,SCRIPTIOR OF WORK.
A/C CHANGE OUT EXACT REPLACEMENT
3 ZA eco m P RP1 ci4QI
CONSTRUCTION INFORMATION--
Additional work to be pertormed under this permit—check allappy:
❑✓_HVAC Gas Tank Gas Piping _Shutters
❑ p ❑Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ `t'��� Utilities:i Sewer❑Septic Building Height:
:'OVIJNER/LESSEI=:-_ CONTRACTO.Rc ;
Name :Tane Rx L-5d,)cy- Name. MARKAVINES
Address: LA3,2 &xc r d la. C i r' Company: AZTIL
City: Pr; Picnz-c State:FL Address: 2540 S MILITARY TRAIL
Zip Code: 39 Fax: City: WEST PALM BEACH State:FL
Phone No. �aA_ Zip Code: 33415 Fax: 561-434-0018
E-Mail: Phone No. 561-433-2197
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: CAC049253
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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:
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 recordingyour Notice of Commencement.
r
s
_Sign ture of Owner/Lessee/Agent Si nature of Con ractor/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF A-.',.6. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9/ day of 20 jW y this,�?/ day of SSP ,20 by
(Name of person acknow ging) (Name of person acknowledging
(Signatur o o P lic-Sta ) Ign ure of Nota Public- a of I 'da )
pVypp rGnI�FFORD °� `YPa� H p GI FORD
Pe O _v O Wdf?k� ntification er qEr l r4>s Pro ced Ill ntification
-' Q.•r I
07742
Ty ic@kY 9&e Typ 5 o
aFF EXPIRES Decem erS Decem ,
11. •• EXPIRE
••.,OF .
Co �dSWPG=1�$®. FloridallotarySeryice.com al) Con tM9tfftOW FloridallotaryService.com eal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
LINITIALS