HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC�ABBL�E�INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: 1 ,5 PermitNumber:
ECEIVED
mdft
Building Permit Applicati®n NOV 2 4 2015
Planning and Development Services
Building and Code Regulation Oivlsion
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: I�
PROPOSED IMPROVEMENT LOCATION: °
Address: "141'0 R(0
Legal Description: .i� � ��� ( �7n���� ✓�1��
Property Tax I D#: Lot No.
Site Plan Name: Block No.
Project Name: --I I-Jt o5 U5 4G
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
CONSTRUCTION INFORMATION:
Additionalworto
nasTank
orme under this perms —check a jht app y:
09VAC E]Gas Piping L=1 Shutters ❑Windows/Doors
11 Electric E]Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq. of First Floor:
I, ®
Cost of Construction:$ V 0 •oUtilities: Sewer Septic Building Height:
OWNER/LESSEE: �: CONTRACTOR:
Name 14.E C7� L �c� Name: CHARLES BEBOUT
Address: t' t Company: AMBER REFRIGERATION
City: �v,�¢,C;ap_� G SrarF FL._ Address: 504 SW LAKE MANATEE WAY
Zip Code: 3�',P&'I Fax! City: HU.KI !$I•LUCIE
Phone NO fip Cade: 34986 Fax,
! Mail: Phone No. i�?-5211-5 86
FIII in fee simple Title Holder on next page(if different E-Mail: amberre;frigeration@yahoo.com
from the Owner listed above) State or County License: CAC1814270
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. a 1 I 1
PLEMEN'TAL'C NS,TR,UCTI( N LIEN A+UUIN FI?R /iAiTION:
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:
I 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.
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 apermit 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 recordinil your Notice of Commencement.
4
I Signature o Owner/Agent/Lessee Signature o ontractor/License Holder
i STATE OF FLORIDA�-\ STATE OF FLORIDA c;
COUNTY OF LLf'�i COUNTY OF
i
The forgoing instrument was��afck^^nowled ed before me The for ng Instr�um��ent was cknowledged before me
} th"_Aay ofvlQ&06�\ ,20by t�ay of •20_0by
(Name of person acknowledging) (Name of person acknowledging)
k
I
(Sig tune of Notary Public-State of Florida) (Signature of Notary Pub State of Florida) r
? Personal{ Known OR Produced Identification Personally Known Notary
Rrodueed
Personally —
DEBORAH RUSSELL
9 ofldentification Preduc
Y Type of Identification Produced .Y ( rza,
DEBORAH RU33ELL �, z°. �= Notary Public State of Florid
Commission No. ,s aY� I) �ir'IQ j�$i4n No `t ` `° •=My H.Expires Nov 30 201
o
Not Public-St .e e ,Qr
°c'=M Comm.Expires ov 30,201 B .;, Commission#FF 179630
Commission ,
ketiqsed 07/15,/2014 %eRf„�° Bonded through National Notary Assn.'
ti
{ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
l COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED i
DATE
COMPLETED