HomeMy WebLinkAboutBuilding Permit Application From:Air Repair Solutions,IFax:(800)757-0066 To: Fax: +1(772)462-1578 Page 2 of 3 1012112015 1:42 PM
ALL APPLICABLE INF.O.,MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,�7 _
Rate; Permit Number: ��� i/
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Building Permit Application
Planning and Development Services OCT � ' 2015
Building and Ccide 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 arrow at the end of line
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Address: CA &QL(�6c' C
Legal Description:r cyn 1 ( ,re_ 1399 21a).
Property Tax ID#: 01"dot-I06-2. Lot No.
Site-Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Itlona wor to a e 'orme un er t (s permit-c ec a app y:'
HVAC 1,Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator FIRoof
Total Sq.Ft of Construction: SQ. Ft.of First Floor:
Cost of Construction:$ Utilities:L_ISewer Septic Building Height:
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Name C Name: (fieI(jogs
Address:
Company.: tSb�lcxti5
City C�- ctr[.e- State:F AddreCtssss:_4=J
Zi.p Code._ 40459!a Fax: City:. State:_a.
Phone No.71, 2--�1o�? 0 Zip Code: @ i Fa c-111-=-c�71S9
E-Mail: Phone No.
Fill.in fee simple Title Holder on next page(if different E-Mail:QtrCeo C 50$y4-iares(24-ntLJ
from the Owner listed above) State or County License: (� C' [ 1� d
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
From:Air Repair solutions,Max:(800)757-0066 To: Fax: +1(772)462.1578 Page 3 of 3 1012112015 1:4.2 PM
DESIGNERANGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEESIMPLE 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 grantinga 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 mayrestrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which mayapply.
in consideration of the granting:of this requested permit,l do hereby agree that.1 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 Commericement may result in your haying 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
commencin work or recordigg your Notice of Commencement.
S
_Signature of Owner/Lessee/Agent Signature of Contractolr¢1 icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF V__ COUNTY of S4r- UU6-e..
Th.e far oing,instr m nt was acknowledged before me The forgoing instrument was acknowledged before me
thisday of 24- by this day of 20 l by
�c'as- {'y. e '
(Name of person acknowledging) (Name of person acknowledging)
(Signaturkoj Notary Public-State of Florida} (Signature f otary Public-State of Florida}
Personally Known)�!OR Produced Identification Personally Known OR Produced identification
Type of Identificati .n Produced Type of Identificatio. Produced
HOLLY NIC "% L SKl
4MMlSSlflN FF 142732OMMISSION#FF 142732
Commission No. (� # Commission i�a. Z 3" *
E [RES:August 5,2018 s, IKES:August 542018
qr ejOe BoiidadThruBUWNotary services 40SL�W'
13OW" Bonde RnBudget Notary services
FaFeio
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS