HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_q 1'3 Permit Number: /&P/—0/0
RECE-:9w
Building Permit Application JAN 13 2oj6
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 Residential_X_
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVEMENT LOCATION,
Address: _b Ito Cn(l 0-41C
Legal Description:
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Property Tax ID#: 14 25 PQ 00 —co' Lot No.
Site Plan Name: Block No,
Project Name:
Setbacks Front Back-. Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
AdditionaiworKtobeoertOrme d under this permit-check all t12.at apply:
2;HVAC Gas Tank Flas Piping F�Shutters Windows/Doors
[ElectricPlumbing F Sprinklers liGenerator Roof
Total Sq.rt of Construction: Sq. Ft.of First Floor:
Cost of Construction: ';000.nc) Utilities:F. Sewer[]Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name: RALPH WARREN
Ad8iess: j;;? Company: AIRFLOW A/C AND HEATING
City: , 4t 'torso 742. Statef-4V Address: 50 NE DIXIE HWY SUITE 0-1
Zip Code: I Fax: City: STUART State:fL_
Phone No. Zip Code: 34994 Fax:
E-Mail: Phone No. 772-781-42665
Fill In fee simple Title Holder on next page(if different E-Mail: airflowacfl@gmaii.com
from the Owner listed above) State or County License: CAC1817930
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required..
` SUPPLEMEfiVAfi.C'fJN5TRfiJCTitJN fi.fiEfiV fi.AW fiNFQRiVIATfiONfi;"
DESIGNER/ENGINEER: �Not Applicable MORTGAGE COMPANY: `Not Applicable
Name: Name:
Address: Address:
City: State: City: State: x
Zip- Phone: Zip: Phone: t
f
FEE SIMPLE TITLE HOLDER: _Not Applicable _ BONDING COMPANY: _Not Applicable r
Name: Name:
Address: Address:
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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 :Y
structure, Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the g-anting of this requested permit,I do hereby agree that I will,in all respects,perform the work t
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 J41
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
c9mmencing work or recording your Notice of Commencement.
Signature oY Owner/Agent/Lessee Signatur of Contractor/License Holder y
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF `s�'� (, (�( �i�� COLINTY OF
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The forgoing instrument was acknowledged before me The for Ing instrument was acknowledged before me k
this 'f1R'ay of C�� � 20�by this�ay of �� ZQ�by
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(Name of per on acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of.Florida
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of identification Produced
Commission N48 —DEBOR!(8(f SELL Commission No. ++ DEBOWALIS SELL � �}
l-; Notary Public-State of Florida = Notary Public-State of Florida 4
Expires-N.ou-3A.2A•t8 ': y-,Gomm—ExWtes Atau3D,20-13�
,Nf «QQ`- �N�M «QQ, Commission#FF 179630
gT �.,. Commission#FF 179630 .;T� a4,.' i.
Revised 07° 5"I'QdF ``, Bonded through National Notary Assn. ' °f++" Bonded through National Notary Assn.I,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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