HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
-A 1!5—
Date: L Permit Number:
RECEIVED
Building Permit Application NOV 2 4 2015
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/ Residential
PERMIT APPLICATION FOR:
14W6
—PROPOSED INPROVEMENT LOCATION:
—1 !A J 0 !S LA_ 14
Address: S
Legal Description:.__ rep L-C-k�
Property Tax ID#: C)C>^ Lot No.
Site Plan Name: Block No.
Project Name: MiQ en+-
%J
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
53 7110 G'us 4ey-ra --1,21 5545'0
CONSTRU
,TION INFORMATION:
—Additional work to be 10 rtormed under this permit—check all that apply:
LHVAC Gas Tank "Shutters E]Windows/Doors
FIGas Piping
11 Electric EJ Plumbing '®Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq. Ft.of First(
irst Floor:
Cost of Construction:$AOAE'bx�)o Utilities:[—]Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name n L4(0 1 IS U:)JL Name: CHARLES SEBOUT
Address:,,9'2 Company: AMBER REFRIGERATION
0t4'" Pbr'k-N State-'FL_. Address- 504 SW LAKE MANATEE._WAY__.
Zip Code: ID-306-1- F8X! City: HU.K J �1.LUCIE
Phone No � 12 71p(-.Qde: 349RR -
E Mail:
Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: cmberrefrigeration@yahoo.com
from the Owner listed above) State or County License: CACI 814270
1
if value of construction is$2500 or more,a RECORDED Notice of commencement is required.
SUPPL MENTAL CdMSTRUCYit N i.� # 1W tNFORMAT] r
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
i Address: Address:
5 City: City:
E 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 the germit holder to build the subject structure
which Is In conflict with any applicable Home Owners Assoc ation 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.
f
1;
SignatureoOwner/Agent/Lessee Signature o ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
i. COUNTY OF -iD WAS-66WAS-66 COUNTY OF 5-b Lc.tace _—
The�for�g�o,ing instru ent was acknouded ed before me The for oing}nstr ment was ac cnowledged before me
this_TT"day of by this
=day of .20_W by
I
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public State of Florida)
Personally Known V-1" _O _P od.�ce})Identification Personally Known �OR Produced Identification
S Type of Identification, odµa�nom*,- OfifF3itAf#itttSSEI� pe of Identifica:tion```rod[rce
t �s' """�,, DEBORAH RUSSELL
Nott Ppbllc-State of Florid o�'�aY nve�:'�.
Commission No. - ea mmission No. Notary PuNfulat)late of Florida
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My C mm. xpires Nov 30,201 '•; ; My Comm.Expires Nov 30,2018
J '.;rF °•` Commission#FF 179830 =N." 'Q:
Bonded through National Notary Assn. °;;°`O� Bonded through National Notary Assn.
Re-!Scd 0,11/15/2- ' 4
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