HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
,:. RECEIVE®
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)4624553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVE MENTLOCATION
_, . ... :
Address:.(S F--�\X!Y
Legal Description:-f�''72;:= A q 6f- ,
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PropertyTax ID#: Lot No.
Site Plan Name: Block No.
Project Name: r_X_Qrv'I►':�n
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O,F WORK
CONSTRUCTION 1NF0RMATION ,
... ,,,..
Additional work to ne e orme under this permit-check all thn apply:
✓HVAC 0Gas Tank FGas Piping _Shutters Windows/Doors
Electric El Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction:c2-1-_�) Y-A S . Ft.of First Floor:
Cost of Construction:$ Utilities. Sewer OSeptic Building Height:
OWNER/LESSEE CONTRACTOR
Name\t\7. 3:2CUC`a\� (\ Name: MICHAEL EWING
Address: 1� C mpany: PIONEER COOLING&HEATING
City:t DaKQ=�C� State:FIL Address: 585 NW MERCANTILE PLACE# 106
Zip Code;ZXa(5�D Fax: City: PORT ST LUCIE State:FL
Phone No:— Zip Code: 34986 Fax:
E-Mail: Phone No. 772-579-9209
Fill in fee simple Title Holder on next page(if different E-Mail: Pioneerheatingco@bellsouth.net
from the Owner listed above) State or County License: CAC1817251
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
N
Sl1`PPLEMENTAL CONSTRUCTION L'IENLAWj IFORMATION = d
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:
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 a permit 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 recording our Notice of Commencement.
J A
Signature of Owner/ ent/Lessee Signature of Contractor/U ense Holder
STATE OF FL A STATE OF FLORID
COUNTY OF COUNTY OF
The forg 'ng inst ent was cknowled ed before me The forgo' instru ent was acknowledged before me
th day of 20 by this,254 of ►�i�l.L .2010by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of NotaryPublic- tate of.Florida) (Signature of Notary Public-State of orida)
Personally Known ✓ • OR Produced Identification Personally Known V-11-0,11
/OR Produced Identification
Type..of Identification Produced Type of Identification Produced
Commission No. " ' ��
t s dit@NAH RUSSELL Commission No. µ y� DEB0ftP*SSELL
aA, *
No Public State of Florida a°�, o4�c;`Notary Public-State of Florida
' ' tr ° ov 30 2018
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` ;r Commission#FF 179630 E' ;." °oe Commission#FF 179630 .
Revised 07/0/2014'�F�;;; Bonded through National Notary Assn. %FOS F�°4` Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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