HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
. LAA1..,. RECEIVED JAN 2 6 2016
51 "411)'21Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4621553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR:. Mechanical -
0
PROPOSED IMPROVEMENT LOCATION
Address:-1`-l �
Legal-Descriptions rY-1 47J-011(7�.4r- \-I %\l 0Cr_\0rY iI r�",tel
Property Tax ID#k35z-12-( Q(:[ Q- OpIn -C r_n-
Lot No.
Site Plan Name: Block No.
Project Name: jl
Setbacks Front- Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
-�
4 C (�rP Q►na cPor,LlPY1� - -
CONSTRUCTION INFORMATION
Additional worK to b rforme under this perms -c ec a appy:
✓ZHVAC Gas Tank Gas Piping _.Shutters Windows Doors
a o ,
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: lOQ^7 Sq. Ft.of First Floor:
Cost of Construction: 0 50 Utilities: Sewer OSeptic Building Height:
OWNER/LESSEE CONTRACTOR
NameK:V Name: PATRICK FLETCHALL
Addressc�3 3P Company: COOL&RELIABLE AIR COND
City: /-C-A State-1Xliq Address: 1051 NE SANTA CRUZ DR
Zip Code: 1Cj�. Fax: City: JENSEN BEACH .State:FL
Phone No. Zip Code: 34957 Fax:
E-Mail: Phone No. 772-692-5760
Fill in fee simple Title Holder on next page(if different E-Mail: r-cool@bellsouth.net
from the Owner listed above) State or County License: CAC058567
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CbNSTRUC�'iON LIEN IAW INFOf�MATION
DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: Not-Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Tip: 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
commencina work or recardina vour Notice of Commencement.
Sig ure of Owner/ ent/Lessee V ature of Cont or icense Holder
STATE OF FLORIDA .� STATE OF FL RID 1 '
COUNTY OF s� . I-•�C-�L= COUNTY OF
Theo oing instrument was acknowleded before me. Theo going instrument was acknowledged before me
thi day of t4M9.�,20by thi` !Qdayof-7mhl .2610by
aG T�Sve, -plz_�
joame4jtperson ackno ging (Name rson.ack owledging
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally KnownOR Produced Identification Personally Known.) R Produced Identification
Type of identification Produced Type of Identification roduced
Commission No. 1 (Seal) Commission No. (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 -
+..JPT SHAWN ARUSSELL--- ---- ;ffly�.vs_
PwYP� � SHAWN A_RUSSELL
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20i rani =2. %0 - Notary Public-State of Florida _ _ Notary Public-State of Florida
N� MyComm.Expires Mar 11,2016 �sQ My Comm.Expires Mar 11,2016
OFF op�' Commission#EE 178096 ''�,,,eoFF�o `• Commission#EE 178096
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