HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I / VtiIJ .
RECEIVED
_
_ _ ______.� Building Permit Application OCT Z 2 2015
Planning and Development Services
Building and Code Regulation Division -
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone:(772)462-1553 Fax:(772)462-2578 Commercial Residential —
PERMIT APPLICATION FOR: Mechanical
PROPOSED lNPROVEMENT LOCATION . ,
Address: 5C>0
Legal Description:' mi!o'u r g Utni: J Rn,=Q
Property Tax I D#: J (QCT o d -� C�£�D Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
777771
DETAILED,DE SCR(PT1ON OF WORK
CONSTRUCTICJN INFORMATIQN
itiona ir to e a orme l under this permit-c ec a appy:
Z HVAC OGasTank ❑Gas Piping nGenerator
Shutters a Windows/Doors11 Electric Q Plumbing [ISprinklers Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities Sewer Septic Building Height:
OWNER/LESSEE.. CONTRACTQR
Name a MICHAEL EWING0 �
Address: L2edo!j -rQD S Tri Company: PIONEER COOLING&HEATING
City::...�....t��.b
State:NN Address: 585 NW MERCANTILE PLACE#106
Zip Code: V MJLO� 7 Fax: City:PORT ST LUCIE State:FL
Phone No. Zip Code: 34986 Fax:
E-Mail: Phone No. 772-579-9209
Fill In fee simple Title Holder on next page(if different E-Mail: pioneerheatingco@bellsouth.net
from the Owner listed above) State or County License: CACI 817251
if value of construction is$2500 or more,a.RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:�� _Not Applicable MORTGAGE COMPANY: n 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:Applicationis 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.whi.h 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.
J.
Signature of Owner/ ent/Lessee ignature of Contractor/Lt ense Holder
STATE OF FL STATE OF FLORID
COUNTY OF COUNTY OF
The forgoyg instrument was acknowled ed before me The forgo-up instrument as acknowledged before me
th 'day of j�(� fl f 20�by thi ay of . 200 by
(Name of person acknowledging) (Name of person acknowledging
(Sigriaturebf Notary Public- tate of Florida) (Signature of Notary Publ�ic-State of Florida)
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type:.of Identification Produced Type of Identification Produce
�•��Rv'�'�• DEBORAH RUSSELL
Commission No. ,a�"'i��,, ,to UB
(SMBOFAH RUSSELL ommission No. 'a°��,`� S@ y Public-State of Flo a
Notary Public State of Florid = : •;My Comm.Expires Nov 30, 18
x -res Nav 30,201 -"ql Commission#FF 1796
Commission#FF 179630 Bonded through National Notary I sn.
Revised 07/15/20.1 Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED