HomeMy WebLinkAboutBuilding Permit Application (2) Feb 02 2016 05:33PM Florida Delta Mechanical 8662190729 page 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i /lt_orr��
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Dater Permit Number: i ^c0Lls—
Building Permit Application
Planning and Development Services
Building and code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 Y
Phone: (772)462-1553 Fax:(772)462-1578 .. Commercial Residential
PERMIT APPLICATION FOR: o Selectfrom dropbox, click-(fere
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Address: 4q 4r0 Amami U vt
Legal Description: �r�.sr.7 &crt S V v. T',•,v 5Ij] LOT Z
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Property Tax I #: (K30 -70 E - 0010- Qoo .- Lot No. L-'—.
Site Plan Name: Block No. L
Project Name: i d i fri
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MONO �d t}.. ..., a ..s-- .tith>�tI, "'i- [`ta t�l,l��t iii°in
it€ona I Work to e erformed un er t is permit—c ec all that apply:
❑HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
11 Electric IJ Plumbing ❑Sprinklers 11 Generator F�Roof
Total Sq, Ft of Construction: `` SFt.of First Floor:
Cost of Construction:$ l� UtilitiestSewer EiSeptic Building Height:
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Name •clt.�.r (A 21 nn-e-ft-
Address: C r M ve— Company: r �s. ec ,Nd
City: oc y, Vow State:.L1�. Address _ 027 f �:r c;�,i
Zip Code: (SS-S-7 Fax:
City: da Stater
Phone No. ?I q- 2 33-- ?76 9,- Zip Code: 37sra Fax: AC6- Z19_ 07 Z9
E-Mail: Phone No. 99X-' 2-0- O �
FlII In fee simple Title Holder on next page(If different E-Mail: rry I -fa 4 A r
from the Owner listed above) State or County License: &C 1V,9S-9 j'7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Feb OZ 2015 05B3PM Florida Delta Mechanical 8662190729 page 2
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DESIGNERANGINEER! Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Add ress:
City: State:— City. State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _NotApplica.ble 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.Lucle.Coun makes no representation that Is granting a permit will authorize the permit holder to build the subject structure
which is in conAct 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 vilh Ich 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 flFA inspection. If ypu intend to obtain financing,consult witp�nder or an attorney before
commencing work or r4cordi6k your Notice of Commencement.
Signature of, wner/Agenf/Less& Signature of contrVc—tor/License Holder
STATE OF FLORIDA STATE OF FL,ORO J I
20 by this N day of.
e of person acknowledging)
a e of person acknowledging)
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(Signature of ry Public-state of F(orlda J Notary Public-St,XJ,of FI da
Personally Known OR Produced Identification Personaily Known OR Produced Identification—
Type of Identifiratlein Produced Type of Identification Produced
commission No P 112M 11 E (Seal) Commission No.Fc-.'2"a Oe 14
J ASHLEY NIC ZIEGENGEIST
ASHLEY NICOLE ZIEGENGEIST 1, 1 ; MVCO missiom*FFiPn71P
MY COMMISSION#FF-120712 EXPiRES May 7,2018
Revised 07/1!
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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