HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ja-C1' 15 Permit Number: ' a- 0 lcoq
RECEIVED
Building Permit Application DEC 0 9 2015
Planning and Development Services PERMITTING
Building and Code Regulation Division ,c e r ounty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial ?� Residential _
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVEMENT LOCATION:
Address: R` ( Q [yj=nn An—iie, V-> _
Legal Description: C'`� 'C_Q 2F G_ CtX-171C)rY11,�
Property Tax ID#: fir- ��7Q � (�1L91.. [�']�- �t Lot No.
Site Pian Name: Block No.
Project Name:Z)(zF'1!g- 1�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�X�� r-Pa�I a�rP�1- l� � � -tsz� �S �P 1r•-
CONSTRUCTION INFORMATION:
Additional work toorme under this permit-check a appy:
HVAC flGas Tank Gas Piping _Shutters �Windows/Doors
11 Electric 0 Plumbing Sprinklers FI Generator Roof
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction:$ F-751 Utilities:n Sewer 0Septic Building Height:
OW N ERAESSEE: CONTRACTOR:
NameMAY]= J� D ['Y.0 v Name: THEODORE MANN
Address:lln Ail'Y�F` -j� �LJ Company: AC MANN INC
city!,�'if1G a21l_X4iSY1 State: l� Address. 1050 SW BILTMORE STREET
Zip Code:k-2�5L_R_L_Q_ Fax: City: PORT ST LUCIE State:FL
Phone No. Zip Code: 34983 Fax:
t
E-Mail: �- Phone No. 772-340-4604
Fill in fee simple Title Holder on next page(if different E-Mail: pslacmann@aol.com
from the Owner listed above) State or County License: CAC1814425
i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
St I'I �, CONSTRUMN UER LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable pp 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.
1 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 df Owner/Agent/Lessee Signaturd of Contractor/License Holder
STATE OF FLORIDA STATE OF,u-)� COUNTY OFORIDA
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing inst ument was acknowledged before me
this y of �e c,��F..� _ by this�{4Jay of� �a lr%g ,20E5Dby
(Name of person acknowledgin ) (Name of person acknowledgin
J
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known JAI OR Produced Identification Personally Known OR Produced Identification
Type of identification Produced Type of Identification Produced
Commission No.eiE Ine0"ILS (Seal) Commission No.46k—v 1_'1�'On t-k (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED J`04P�YPFSHAWN A R SSELL
* :U.SNotary Public-State of Florida °o` a,' SHAWN
- State of Florida
••i,FOF F�0P``` Commission#EE 178096 =r o=r My Comm.Expires Mar 11,2016
OFF
OF Commission#EE 178096