HomeMy WebLinkAboutBuilding Permit Application Sep 28 15 06:09a Honest Air, Inc. 772-232-1118 p.1
ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BEACCEPTED
Date: 5 Permit Number:
5� RECEIVED SEP 29.
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: To Select from dropbox, click arrow at the end of line v QG
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: ail r
Property Tax ID#: s If — g5fi o' I — 000--? Lot No.
Site Plan Name: C 601-J Co,S'ItA't-C4:7 L Block No. 3
Project Name:
Setbacks Front Back: might Side: Left Side:
DETAILED DESCRIPTION.OF WORK:
lil y FO2 I-VC A C 5 W 7" It'ITT
ly s�
CONSTRUCTION INFORMATION:
Additionalworktopenerformed under tis permit—check all 1=appy:
ZHVAC Gas Tank ❑Gas Piping _Shutters I_._.i Windows/Doors
FiElectric ❑ Plumbing Sprinklers Generator a Roof
Total Sq.Ft of Construction: SCI. Ft.of First Floor:
Cost of Construction:$ -3 56 - /� Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name L Name:
Address: 3uS Company: o-v iii /U
City: State: F74 Address: L �� f4j)
Zip Code: 34 5 S�2 Fax: City: t Stater,
Phone No. -27_2 Zip Code: '5 q d Fax: 17r 3_2'1/4.
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: q•Z1�5i9d t� �LLLSLYJW.N�`��
from the Owner listed above) State or County License: 1� r0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Sep 2815 06:09a Honest Air, Inc. 772-232-1118 p.2
S�-1PPLEME,NTAL'.CQNSTRU.C�T16N UMl:A1N:tNFOR.11tIAT10N�.. : ..
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: .
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: ____Not Applicable BONDING COMPANY: Not Applicable
Name: Name: T
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'nspection. If you intend to obtain financing,consult with lender or an attorney before
commencin rk otfrecgriding your Notice of Commencement.
/4"Aelf s
_Signature of Owner/Lessee) a Signature of Cont actor/Lic older
STATE OF FLORIDAtxw
STATE OF FLORIDA
I.
COUNTY OF COUNTY OF
The forgoing rostrum t was acknowledged before me The forgoing instrument was acknowledged,b Rare me
this day of _zed 20 Jby this 2 C� day of _ .Q077 20 6y
(Name of person acknowledging) (Name of person acknowledging}
(Signature of No Public-Stat of Florida} (Signature of Notary Publi . State of F ida I
Personally Know R Produced Identification Personally Known oly OR Produced Identification
Type of Identification Produced Type of Identification Prod ced QA
09
43
Commission No. �i�+� „a s 'r�' Commission No. y a1
6102 IZIisr&yseud)G :' a
6602'Z I Isn6ny sa�1dx3 r
Revised 07/15/201 ,t`�i2338a00Msi1jH0 •'' (r`, D6106 id#uolsslwwo0
ANN21eaoom S141.13
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS