HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit
RECEIVED
Building Permit Application NOV 2 4 205
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 v"I Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address:-1y-10
Legal Description: (!ea�ra� f
Property Tax fD#- OL42'p
- 5:"� Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: rX e3 eq, r,-,7 16jro Mer:-j—
C S(48�nrz t, ,L44-, At:>
CONSTRUCTION INFORMATION:
Additional work tobe rformed -u—nder this perhilif--ch,111 11 apply:
HVAC . Gas Tank r�Gas Piping Shutters E]Windows/Doors
Electric F-1 Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor.,
Cost of Construction:$ -2?1nC) -QQ Utilities:0Sewer Fleptic Building Height:
OWNERAESSEE: CONTRACTOR:
Name:�?qiec> U,5 [ALk',u Name: CHARLES BESOUT
Address; 0 0—ILL)s4w Sin- Company: AMBER REFRIGERATION
citv. FL Address: 504 SW LAKE MANATEE WAY
Zip Code: 506 Lnot FOR! PV*H I $I.LUILAE -ft
Phone Np 7ip
Ode: 349R6 Fax;
h--Mail: Phone Na. (0-5W-5986
Fill in fee simple Title Holder on next page I if different E-Mail: amberrefrigeration Cwyahoo.com
from the Owner listed above) State or County License: CAC1814270
I
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEfiiT11l CONSTR17CTi0N i:tEiV A►W.iNFORikTiOIV
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:
E Address: Address:
s 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.
Signature"Towner/Agent/Lessee Signature o ontractor/License Holder
i STATE OF FLORID� STATE OF FLORIDA
COUNTY OF4— COUNTY OF 5C Li ('e
!
The for o' g instru ent was a Howled egd_before me The f^ rgo�g Insttnent was acknowledged before me
tfit day of ( L n` 20�jby thi��=SCday of `DIO-�- 20[Mby
i
I (Name of person acknowledging) (Name of person acknowledging)
f (Signature of Not Publ'c State f Flo' a)' (Signature of Notary Public-State o Florida)
s Personally Known �_OR Produced Identification Personally Known O r u. d,.d U Ica-app xy F
T e of Identification Produ a ��„ , DEBO RAH RiiccFi L s ;
Type of Identification Produced Vp
otar Public-State of Flo a
Commission No. AH RUSSELL ;t:. Commission Na = + * _
EB m.Expires Nov 30; 1 S ff
i ,,tPaY�r sr; public State of Florida ir9F oho; Commission#FF 1796 Pa
otar PIWLal
QUI
Ex ire 'AVI•_My Comm. pRevised 07/1512 ; JQ Commission#FF 179630
ded through National Notary
Assn.
REVIEWS FRONT ZONISUPERVISOR PLANS V
NG EGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED