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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number:
RECEIVE[
Building Permit Application NOV 1`7 2015
Planning and Deveioprrient Services
Building vnd Code Regulation Division
2340 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR.- Mechanical '
PROPOSED INPROVEM.ENT LOCATION:
Address:
Legal Description, 4 C t F--,aa 1
Property Tax ID#: Lot No.
Site.Plan Name Block No._(
Project Name: Z&?U2ers
Setbacks r"ront Back. Right Side: Left Side:
DETAIiED DWRIPTION OF WORK:
112 -AJ 1 Lf Seer _t C ��,P_ (tzt°-�' to i-f-f-�
I`ZZ U) hk
CONSTRUCTION INFORMATION:
+ +o<na wor to a oertormed under t is permit-check all appy:
HVAC E]Gas Tank Gas Piping Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator F� Roof
Total Sq.Ft of Construction: /] -)U(P-7 S . Ft.of First Floor:
Cost of Construction:S /J <._ utilities:Sewer 0 Septic Building Height.
OWNER/LESSEE: CONTRACTOR:
Name. t` ,1' (At Name: RALPH WARREN
AddCompany: AIRFLOW,AJC AND HEATING
i
City: State:FL Address: 50 NE DIXIE HWY SUITE D-1
Zip Code; �J Fax: `" City: STUART State:FL
Phone No. '�96;>-7 <2i'_9 57li Zip Code: 34994 Fax:
E-Mail: "' Phone No. 772-761-2665 l
i
Fill in fee simple Title Holder on next page(if different E-Mail: airflawacfi@a 9mail.c0m
from the Owner listed above) State or County License: CAC1817930 s
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if value of construction is SZ500 or more,a RECORDED Notice of Commencement is required.
mss.
:SUPPLEMENTALCONSTRUGTiQN LIEN LAW iNi~ORMATI{]N, ; r
a�
DESIGNER/ENGINEER: __ Not Applicable MORTGAGE COMPANY: Not Applicable 4
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: X
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable p
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. P
I certify that no work or installation has commenced prior to the issuance of a permit.
St.LucieCounty makes no representation that is granting a permit will authorize the permit holder to build the subject,structure
which is in cont►ict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such f
structure.Please consult.with your Home Owners Association and review your deed for any restrictions which may apply. H
In consideration of the granting of this requested permit,I do hereby agree that 1 will,in all respects,perforin 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 t
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 r
ca mencin work or recording our Notice of Commencement.
F
Signature o Owner)AgEntJ Lessee Signatur of Contractor/License Holder f
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5---E L4..e.cc'c_ COUNTY
i
l The forgoing instru ent was acknowled ed before me The forgo'ng instr ent was acknowledged before me
this 'lfay of_ z ,2 b this ay of , f �� ZOQy i
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(Name of person acknowledging) (Dame of person acknowledging) F
{Signature of Notary Public-9tate of Florida) (Signature of Notary Public-State of Florida)
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Personally Known too" OR Produced Identification Personally Known. ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced�Ilnt ,COmm15514n No... py )mmission Na. Y State of Florida
^µ RUSSELL :o �
s R'
a ;My Expires Nnv 36.2n1 `i
Notary Public-Stag r,i ri *. Comm.E p' t
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;).: my Comm.Expires hL I ommiss u
,. tyoss ��`.,E Oi F��4`, Bonded through National�4u
Commission F` tac,r
Revised 07/15/201 7 : z
Bonded through National Notary Assn_
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE f
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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