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HomeMy WebLinkAbout1602-0044.i*UCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:-f _/ t� /ii Permit Number: i Building Permit Application 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 PERMIT APPLICATION FOR: Address: '1700 6t",yi brie r Cf- Legal Description: p Property Tax ID k: ✓3sld-706_0l'3i_0t7� 6 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 0" Addit' nalworktobepertormed under this permit- check all that appy: _Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ S ZO Utilities: _ Sewer _ Septic Building Height: Name Ei/ee'rr /%!. IV/ SG7u Name: CurL(6 SaYnmon S Address: Company: CAus-rum Air 5�jsfems kic. City: !buns li'lsea State: kis' Address: lWe SE `jlrrPen Dr- ZipCode: !05`%x/ Fax: City: PGQT ST UCIP-- State: FL. Phone No. Zip Code: 34qa Fax: 77�1 335 19b a E-Mail: Phone No. 77 3 3a3� Fill in fee simple Title Holder on next page ( if different E-Mail: i4ia el it VIs 0 bells©v-64 • fil e-1 from the Owner listed above) State or County License: CAC 0 S iR 10 - S-hie if value of construction is.25Kor more, a RECORDED Notice of Commencement is required. 7S-0D DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLEHOLDER: _ 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 recordiiiig yourrecord' Notice of Commencement. Signature of Owner/ Agent/lessee Signature of Contractor License Holder STATE OF FLORIDA _ p COUNTY OF /-w STATE OF COUNTY OFORIDA /!,e GG GeGlc� Theforgoing instrumgat Was acknowledged before me this ( day of f 7 . 2Q� by The forgoing instrument was acknowledged before me this day of JCW 20& by AAW41;r t 4,eTls L,, ;V OAS (Name of person acknowledging) (Name of person acknowledging) (Signature of Nota Public- Sta a of Florida) Personally Known i/ OR Produced Identification Type of Identification PrroduQceedA(` ap.:...,CFGi15Td4E B. E7VGI.1 E�Q S!d �/ J �0"• Pa I Commission No. * MYCOMMISSIONiEE EXPIRES: Aprll4, 201 °'t �°� BMW Thuk*MN W60110, (Signature of Notary Public ate of 5j' rida ) Personally Known OR Produced Identification Type of Identification Produced p o ��`; •..°'��� �CHRL"NE B. E /10 /94?o S/ EE 859 H ommission No. 45? J . I YCOMMISSIONMEE859 c" EXPIRES: April 4, 2017 RWod Thru!Wget NoW REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEATURTLE REVIEW MANGROVE REVIEW DATE RECEIVED DATE COMPLETED ev. r ®� '