HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: w Permit Number: 0—
RECEIVED RECEIVE®
Building Permit Application OCT 2 0 2015
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
PROPOSED IMPROVEMENT LOCATION:
Address: 126 Queen Christina
Legal Description: QUEENS COVE-UNIT 1-BLK 9 LOT C(OR 1552-1668:2944-299)
Property Tax ID#: 1414-701-0075-000-2 Lot No.C
Site Plan Name: Block No. 9
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace AC system - Fan Coil and Condenser. Srz UJ EA e —
CONSTRUCTION INFORMATION:
Acid itional work toe ne rformed under this permit—check all appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric El Plumbing Sprinklers E]Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 3995.00 Utilities. Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Mike Hendricks Name: Jeff Crull
Address:126 Queen Christina Ct. Company: Crull Services Inc
City: Fort Pierce State:FL Address: 81 Queens Road
Zip Code: 34949 Fax: City: Fort Pierce State:FL
Phone No.561-329-3960 Zip Code: 34949 Fax:
E-Mail:hendrick_m@bellsouth.net Phone No. 772-332-5138
Fill in fee simple Title Holder on next page(if different E-Mail: jell@crullservices.com
from the Owner listed above) State or County License: CAC1817276
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 TITLEHOLDER: _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 recording our Notice of Commencement.
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Sig Owner/Lessee/Age t ;?�°* ., Signat of C tr o /License Holder
STATE OF FLOSTATE OF FLOR
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged,bgfo o c The forgoing instryrpent was acknowledged before m b;
this day of 20 LJ by �S< this � lay of (�`-�i ___'20
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me of person acknowledging) "1 (Name of person acknowledging) Maim
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(Signature of No Public-State of Florida) (Signature of Not6ly Public-State of Florida")
Personally Known L/ OR Produced Identification Personally Known �/OR Produced Identificati N
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS 1 -7 1 1 1 1 1