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HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC 1- I FO MMUBE COMPLETED:FOR APPLICATION TO BE ACCEPTED . Date: N Per it / m . umber. cia • Building Permit Application 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_ PERMIT APPLICATION FOR: Mechanical PROPOSED IMPROVEMENT LOCATION• Address:82 , O TV1C-- ®YZ Legal Description: �`K'.Y1 Lot No. ?a�, Site Plan Name: ' Block_No. Project NameSCXCX�r� Setbacks Front Back: Right Side: Left Side; QEWLEDL.DESCRIPTION OF WORK, . XGdC�- ��I�c2 �nt v-� c 2.5 +� \Lk.so 5tne-v—,:�, CONSTRUCTION,INFORMATION: Aciditional work to be Dertormed under this permit-cnecK all that apply: 6 HVAC Gas Tank ❑Gas Piping _Shutters Windows Doors Electric 0 Plumbing Sprinklers F-1 Generator F]Roof Total Sq.Ft of Construction: S . Ft.of First Floor: Cost of Construction:$ � .� Utilities:Sewer Septic Building Height: - OVUNER/,LESSEE � ;, CONTRACTOR 4 Name ame:.TODD DEJARNETTE Address:–IU Z DnQeln Company: GX AIR CONDITIONING City: StateACO Address: 1401 SW MEDINA AVE Zip Code: ( n— Fax: City: PORT ST.LUCIE State:Fl- Phone LPhone No. Zip Code: 34953 Fax: E-Mail: Phone No. 772-344-5520 Fill in fee simple Titie Holder on next page(if different E-Mail: 9xairheat a@yahoo.com from.the Owner listed above) State or County License: CAC1814487 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL` CON5TRt1CTION1 (EIVLA1t1/ INFt7RMATIOIVf4° x 'j, � 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: 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. �lgnafure of Owner%Age /Lessee Signature of Contractor/ icense Holder STATE OF FLORIDA y STATE OF FLORIDA COUNTY OF nT" t,'.(!.,I c.5 COUNTY OF. The for oing instrument was acknowledged b, fore me The forgoing instrument was acknowledged before me this day of J d§L4P�Jam, 20�y this�day of l!�U?02F.20-jVy `T'© C)Qt 'aacrrc (Name of person acknowledging) (Name of person acknowledging) Acm <Q�, ­ . (sign to a of Notary Public-State of Flori a) ( lgna ure o Notary Public-State Flori a) Personally Known N OR Produced Identification Personally Known) i _OR Produced Identification Type of IdentificatioA Produced Type of Identification Produced_ Commission No0 Zet,(E' (Seal) Commission No., ` i (Seal) Revise RQ 4 SHjEx RUSSELL ♦SPµ`"U;, o s� SHAWN A RUSSELL 5?: NotaryPublic-State of Florida zN.UP* Comes Mar 11,2e;My C mm.ExpiresMar 11 2016 REVIEWNT Com �� 1780 F? RVISOR PLANS V�i� ,,,BION C RC+iE��O1�t�E178 9is✓IA GROVE r- LJNTFR EW R IEW REVIEW IEW DATE COMPLETE =1NITIALS