HomeMy WebLinkAboutBuilding Permit Application ALL APPLICrABLLEE I FO MUST BE CQAAPLETED FOR APPLICATION TO BE ACCEPTED
Date: t v Permit Number: j l /t✓
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Building Permit Application
Planning and Development Services.
Building and Code.Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982 \
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential \
PERMIT APPLICATION FOR: Mechanical
PRCrPOSED INPROVEM ENT,LOCATION!
Address:
Legal Description: iJf'� � _l lQ'2r`D
Property Tax I D#:'�tffl C-)km' ocn-s o—sLot No.
Site Plan Name: Block No.'ao_
Project Narne:-:V.)J8A
Setbacks Front Back: Right Side: Left Side:
DET UP-aESC .'WTIO.N,OF CIRK
CQNSTRUCTIOU#NFORM; ION:
Additional work to be orme un ert ispermit—check all appy:
HVAC Gas Tank F]Gas Piping _Shutters Q Windows/Doors
Electric ❑Plumbing QSprinklers F]Generator O.Roof
Total Sq.Ft of Construction: 4L4 Sq. Ft.of First Floor:
Cost of Construction:$1G. fi utilities. Sewer❑Septic Building Height:
OWNERAESSEE CONTRACTf)R:
Nam Name: JUDE LONG
Address:919. aA-) _'t'C(2ik.Yh _aV A Company: LONG AIR COND.
City: State:FL Address: 1770 NE 23RD TERR
Zip Code:<:' t--[ Fax: l'-' City: JENSEN BEACH State:FL
Phone No. ----.. Zip Code: 34957 Fax:
E-Mail: Phone No. 772-286-5411
Fill in fee simple Title Holder oriwntixt`page I if different E-Mail: hoplescoz824@att.net
}
from the Owner listed aboue) State or County License: CAC1813863
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required,
Ui'P,'LE1I�ENTAL ,CjON- TRUGTIOM LIEN LOWI1_7NI:URM14Tt.N £ °°° 4 r tt'A '
DESIGNER/ENGINEER: `Not Applicable I MORTGAGE COMPANY: Not Applicable
Name: 1 Name:
Address: ' Address:
I City: State: i City: State: i
I Zip: Phone: ; Zip: Phone:
I FEE SIMPLE TITLE BOLDER: Not Applicable BONDING COMPANY: —Not Applicable
Name: ) Name:
I Address: i Address:
City: ! City:
I Zip: Phone: ; Zip: Phone: i
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 Horne 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
comrnencin work or recording.your Notice of Commencement.
' ature of Own ent/Lessee Si&Mure of Contractor/LEcense Holder
STATE OF FLORIDA. r STATE OF FLORIDA
f COUNTY OF S ; COUNTY OF
s
The f r ing instrumen s acknowledged before me The forg ng instrument.wa acknowledged before me
this ay of 20ja by this�Iay of 2015 by
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{Name of person acknowledging (Nome ofperson acknowledging)
{ (Signature of Notary Publblic-State of Florida) (Signature of Notary Public-State of Florida)
i Personally Known s/ OR Produced identification Personally Known er OR Produced Identification
Type of identification Produced Type of Identifica r u
�.�A;rG, DEBORAH RUSSELL
�y4OJftr DEBO �i}USSELL '1, <P �a;
commission No. .``.Rr���•, ; .} Commission No .v - -Notary Public(%2a4 of Florida
o ary Public-S ate of Florida
i =• * �*'_ _•« My Comm.Expires Nov 30,2018
= « .•_My Comm.Expires Nov 30,2018 :,sM 179630
0�4.^ i Commission#FF 179630 °.`
q oFr.•
j Bo-ded through National Notary Assn.
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