HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
11 INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application OCT 19
Planning and Development Services 2015
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
PROPOS;ED INPRQVEMENT LOCATION
Address:8��{ `ti k��_
Legal Description.�Pnn --3"Z. C-3i-
VOL 2a
Property Tax ID It:�� r Q��- ( � - � ^ . Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK (pie
�7 \U SAY \n
110 �]V-
CONSTRUCTION INFORMATION:
itiona wor to e e orme uncler t is permit-cneck all thatappy:
✓HVAC 0Gas Tank ❑Gas PipingShutters E]Windows/Doors
Electric 0 Plumbing E]Sprinkiers E_Generator Roof
Total Sq.Ft of Construction: 5 Ft.of First Floor:
Cost of Construction:$_ � Utilities:T]Sewer ElSeptic Building Height:
OWNER/LESSEE CONTRACTOR.
Name� Name: MICHAEL EWING
Address:;_���p��(}��(1 Company: PIONEER COOLING&HEATING
City:12 1)\a StateK A0 Address: 585 NW MERCANTILE PLACE#106
Zip Coder;.. Fax: City: PORT ST LUCIE State:FL
Phone No.-1-12- Zip Code: 34986 Fax:
E-Mail: Phone No. 772-579-9209
Fill in feesimple 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.
SUPPLEMENTAL CONSTRUCTION LIEN Li4W INFORMATION Y
f �.`+r s.. ,' e !` i eE., :'3,, 4 S a .'k�'Kt •e 3 tax _
DESIGNER/ENGINEER: Not Applicable PP 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.
A s r� ,
Signature of Owner/ ent/Lessee ignature of Contractor/Li ense Holder
STATE OF FL A STATE OF FLORID
COUNTY OF �+ - I LcC'i E . COUNTY OF SL " L F
The forgoing instrument was acknowled ed before me The fD,rCg�,oing instrument was acknowledged before me
this 66"-day of�,( p� .20US by this j ay of azz 20®by
(Name of person acknowledging) (Name of person acknowledgin
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known��OR Produced identification
Type:of Identification Produced Type of Identification P
DEBORAH RUSSELL
Commission No. Commission No. NotarMtl�-State of Florida
DEBORAH RUSSELL �"� pec My Comm.Expires Nov 30,2018
Notary Pubt _ =,9, ��.• Commission#FF 179610
y Comm. a a ''�� �" Bonded through National Notary Assn.
�Q: Expires Nov 2018
Revised 07/15 2�3 F4 Commission#FF 179630
Bonded through Natio
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