HomeMy WebLinkAboutBuilding Permit Application h:
ALL APPLICABLE i FO us MPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 15 ..
II
;. Building Permit Application
Planning and Development Services
Sanding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone,(772)462-1553 Fax:(772)4.62-1578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED tNPROVEMENT LOCATION:
Address: . (^ne _ - -,A
Legal Description: �A'-Y-"� \g a\1cgzn� =+�f -Y� _ •_Qi1C) ~-3 C a
Property Tax ID C - I i'---!S Lot No.
Site Plan Name: Block No,
Project Name: �� }tet Z.
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF\NARK:
�XQA—
LCONSTRUCTION.INFORMATION:
AdditionalWorKtobegerformed uncler this permit—check all t=appy:
QHVAC Gas Tank Paas PipingShutters Windows/Doors
Electric o Plumbing Sprinklers Fleneratcr Roof
Total Sq.Ft of Construction: _VE� Sq. Ft.of First Floor:
Cost of Construction: utilities: Sewer OSeptic Building Haight:
0 WNEIRAESSEE: CONTRACTOR:
Na me�iLl(�+�f�C>--��y3C �( �Y2"�- tom_ Name: RALPH WARREN
Add ress:'?1-A iS• �-21, wl::;� Company: AIRFLOW AJC AND HEATING
City:0_eA`4,E= -�1 �-�. State:F Address: 5 NE DIXIE HWY SUETS D-1 1
4
Zip Coder&LJEL � Fax: City: STUART State:FL
Phone No. Zip Code: 34994 Fax: i
E-Mail;. Phone No. 772:-781-2665
Fill in fee simple Title Holder on next page(If different E-Mail: airflc)wac:fl@grnaii.com
from the Owner listed above) State or County License: CAC1817930
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if value of construction is$Z500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFQRMATIaN
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY' _Not Applicable g
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, r
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. t
In consideration of the g-anting of this requested permit,I do hereby agree Lhat I will,in all respects,perforin 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
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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.
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Signature oY Owner/Agent/Lessee Signatur of Contractor/License Holder 4
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF . - �.V(2-,L k&_ COUNTY OF _�.
1 The forgoing instrument was acknowledged before me The for Ling instrument was acknowledged before me
{ My_ylky 20�'by thi�dayo rt�20QMby n,
(Name of person ackno (Name of person ack J
4.
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(Signature of Notary Public-State of Florida j (Signat re of Notary Public-State of Florida I
Personally Known OR Produced Identification Personally Known ucOR Produced Identification xj
Type of Identification Produced Type of Identifio ti Proded
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Commission No. all Commission No,
�.�u°��••. ;I SHAWN A RUSSELL ii
I ,o1P�+rp�err� SHAWN A RUSSELL :_+ .�'
e, • �lJotar-y--ubji"tate-of-Florida—
Notary Public-State of Florida M Comm.Expires Mar 11,2016
Revised r� ' My Comm.Expires Mar 11,2016 .F o ;� y p
� Commission#EE 178096 ;,.• Commission#EE 178096
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE a
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW I'
DATE
RECEIVED - I
DATE
COMPLETED E