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ALL'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number; /I V /f
, _ r IIIIYr10 RECEIVED
i Building Permit Application
Planning.and bevel6pment Services SEP 2 S 2015
Building and Code Regulation,Division
2300 Virginia Avenue,Fort Pierce FL 34982
Prone:{772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PRClPOSED.IMPROVEMENT LOCATION:
Address:
Legal Description. j�
Property Tax ID#: '3'f19 ` L-k0 Q0223 — C10-C-- Lo Lot No.�
Site.Plan Name: �y 1 Block No.
Project Name: 0,i
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION::OF WORK:
Cepate Mef)-I- -3-'o j�'} . t .L4 Seeor
CONSTRUCTION;INFORMATION
ilonaworoe ormeuner is perms —ceca _appy:
HVAC rl Gas Tank []Gas Piping Shutters Windows/Doors
Electric O.Plumbing Sprinklers ❑Generator l...l Roof
Total Sq.Ft of Construction: t-33 J SQ.Ft.of First Floor:
Cost of Construction:$ (00q�*03 Utilities: Sewer Septic Building Height:
OWNERAESSEE CONTRACTOR:
Name Name: CRAIG CANTRELL
Address: LI' SE5 Company: AMTEK AIR CONDITIONING
city---F � I_L-L CLe' State:FL Address: 571 MERCANTILE PL#B-12
tcts
Zip Code: 5� R J Fax: �— City:. PORT ST.LUCIE State:FL
Phone No. _1 Zip Code: 34986 Fax:
&Mail:. '—"�— Phone No. 772-801-3465
Pill in fee simple Title Holder on next page I If different f-Maik amtekac@9mail.c0m -
from the Owner listed above) State or County License: cacl816639
If.value of construction Is S2500 or more,a RECORDED Notice of Commencement Is required.
SCIPPLEMENTAL CONSTRUCTION LIEIU LAW INERMATION
,. ,..
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 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 recording our.Notice of Commencement.
Signatur of.Owner/Agent/Lessee Signature of C ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��' • j /.r'P_� COUNTY OF S�--Lace-e
The forg ing instr en was acknowled ed before me The forgoing instrumentwas acknowledged before me
thi day of _ »th 20�by thi"'day of 20[oby
(Name of pe _ n acknowledging;). (Name of perwi acknowledging)
C� 7
(Signature of Notary Public-State of.Florida) (Signature of Notary: oduced
ublic- tate of Florida)
Personally Known OR Produced Identification Personally-KnowIdentification
Type of Identification Produced Type of Identification Produced
Commission No. a o mission No. ++a,,,,_,(Seal) DEBORAH RUSSEL
DEBORAH RUSSELL ;i°`, ;`= Notary Public-State of IPrida`�o�rav��'9�4, e •Ngta;y01,1aMv Comm.Ex ires Nov 3 Revised 07/15/2QMy Comm.Expires Nov 30,2018', ^,; ¢e;� Commission#FF 179 Q: 9 iiF OF F40.�a� Commission#FF 179630 ''������ Bonded throw h National Notarnndedio a Notar Assn.o-
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