HomeMy WebLinkAboutBuilding Permit Application From:Air Repair Solutions,IFax:(800)757-0066 To: Fax: +1(772)462-1578 Page 2 of 4 11119/2015 10:21 AM
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: !! { /S Permit Number:— —I-�- —
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Building Permit Ap�i� ton NOV 1 J 2015
Planning and Development Services
2015
orl.s
Building and Code Regulution Divisiono�nty, FL
2300 Virginia Avenue,Fort Pierce FL 34982 L e.:
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential ,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR # CEt� t(' 1P11"M ' T t: ATfQN....
Address: //
Legal Description:_�Q t-�� 2 ,'`\
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Property Tax ID#: a�_)�I_ - (A Lot No.��
Site Plan Name:
/� Block No.
Project Name: Lai k(>—
SetbacksFront Back: Right Side: Left Side:
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777
lditi6nal
rYNO' AT wor to De performecl under this permit-c ec a appy:
IL�hiVAC Gas Tank ❑Gas Piping Shutters —1Windows/Doors
11 Electric F] Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 1 COw Utilities:Sewer Septic Building Height:
77 7
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Name Name: n
Address: �(E �hi1l �ih�P� Company: t-�1f''t(V'1�1\Cttl7t.l(�C ifs
City:_-1�GC'� CjL Loc State:T Address:
Zip Code: '��,� Fax: City: -C)C� \>�('(� - State:
Phone No. CAUA Zip Code: Fax: ` N�" Cr,- a—tL-q
E-Mail: Phone No.
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Fill in fee simple Title Holder on next page(if different E-Mail: a1� �-:-..�.._ iCCM
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from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
From:Air Repair Solutions,IFax:(800)757-0066 To: Fax: +1 (772)462-1578 Page 3 of 4 11!1912015 10:21 AM
DESIGNERANGINEER. X_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:
l 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 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 your Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA• STATE OF FLORIDA
COUNTY OF �,Ayap—, COUNTY OF Li X_t Q.-,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this1710, day of� � 20 by thisl2&dayof Wtr len. r___ ,20j5 by
Jrir, IL )1 1 6 i t1 CVt�� 1\t LCI1l�
(Name of person acknowledging) (Name of person acknowledging)
(Signat of Notary Public-State of Florida) (Signatu f Notary Public-State of Florida)
Type of Identification OR Produced Identification Personally Known OR Type of Identification Produced}°.' d ldenti�Y NtICO ER C-
OMM�^ .•..,
Commission No. fp, ISSION+Ff 142732 Commission No. 4`c�� ` jpghGaS:August5,2018
`EXPIRES:August 5,2018 a,NcJ1�' B*NdazySariees
'*'F01F,0'O Bwk Thn Bud0 N6ryServices
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS