HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 5 •O
s J
Building Permit Application
Planning and Developmetit Services
Building and Code.Regulation Division
2.360 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)4624578 Commercial Residential„ ;�—
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION
Address: , ���
Legal bescripti.onzFlt\)Ot" l V_1'\-A7 LQ-
Property Tax ID#:� �� - }� OCX'!-1 OC �C �", Lot No.
Site Plan Name: Block No.
Project-Name t lY1f"''c�MxX l'1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OFWORK
SJSL�m _ A_.
CC}NSTRUCT QN INFORMATION
Additional work to be performed un er t {s permit-check a -app y
ZHVAC i(�l Gas Tank DGas Piping Shutters Windows/Doors
11 Electric �Plumbing sprinklers �Generator F�Roof
Total Sq.Ft of Construction: 2...,. Sq. Ft.of First Floor:
Cost of Construction:$, tea Utilities: Sewer QSeptic Building Height:
QWNER/LESSEE . . . CONTRACTOR:
Narn Name: THEODORE MANN
Address: � �Q4.2 '. Company: AC MANN INC
City: State:FL Address: 1050 SW BILTMORE STREET
Zip Code: Fax: City: PORT ST LUCIE State:FL
Phone No. �^ Zip Code: 34983 Fax:
E-Mail: Phone No. 772-340-4604
Fill in fee simple Title Holder on next page(if different E-Mail: pslacmann@aol.com
from the Owner listed above) State or County License: CAC1814425
if value of construction is$2500 or more,a RECORDED Notice of commencement is required.
SUPPLEMENTAL CONSTRUCTION'LIEN'LA1N INFORM/1TI�N
za, _ n3,
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 thepermit 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.
i
it
Signature df Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF LL,LUOQ e COUNTY OF c._e'e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi day of b rTA r._ 20by thiL__AV&y of [1'0_111:556L_1_ 20[Mby
COO—
(Name of person acknowled ing) (Name of person acknowledging)
(Signature of Notary Publ' -State of Florida} (Signature of Notary Public-State of Florida}
Personally Known Notary
Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
"""'� BORAH RUSSELL ja mmission No.
Commission No. aY n�a�, (SeaQjE RAH RUSSELL
a* *� Notary Public-State of Flori e° �`� Notary Public-State of Florida
My Comm.Expires Nov 30,2 _ -
7 ac RA MM-&PiFes Plat 9-
commission #FF 179630 9� o�ac Commission# FF 179630
Bonded through National Nola Assn.
Revised 07/15/2014 ' "' g y ��F�.••
Wye Bonded through National Notary Assn.
c'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED