HomeMy WebLinkAboutBuilding Permit Application Feb 02 2016 05:29PM Florida Delta Mechanical 8662190729 page 1
ALL APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Q
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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: :To Select,"firom dropbox, click here
P «�jtki+t aE4r t, at
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Address:
Legal Description: Q.0 n7 Re Kor+S ct*,- .i-i V e.. 541,
s
Property Tax ID#: 1410 - 570.'L- 00573_-: 000._ Lot No.
Site Flan Name: Block No.
Project Name:
Setbacks Front Back; Right Side: Left Side:
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KAII Additiona workto
HVAC a Orme un ert rs permit-c ec a apply:
1
Gas Tank ❑Gas Piping .—Shutters Windows/Doors
Electric NiE Plumbing ❑Sprinklers Generator Q Roof
Total Sq.Ft of Construction: ,nS .Ft.of First Floor:
Cost of Construction:$ �1�/(� '0C UtllitiestSewer Septic Building Height:
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Name Pacil K Name. r rn �1/ p
Address: 350 Je $-F. Company: Flar,ede, 11,14; /�ftc +Mice l
City: C UPerbe-C, tA State: Address: 2-'71(a r
Zip Code- Fax: City: —State:
Phone No. q 17 a- (44 60 - QV& Fax: b• (Q•_ 9 9
Zip Code:_ 33SlO 0.'�
E-Mail: Phone No.—? _2(ft- 0.090
Fill in fee simple Title Holder on next page(if different E-Mail: �I.dtr ��� ��a/htcic,,ur 41, �m
from the Owner listed above) State or County License: 671TIVaS217
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Feb 02 2015 0529PM Florida Delta Mechanical 8682190729 ` page 2
DESIG NGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE 14OLDER: Not Applicable SONDING 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 ermit holder to build the subject structure'
which Is In conflict with any applicable Home Owners Association rules,bylaws or angcovenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration 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 yourpaying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the fpt inspection. If you intend to obtain financing,consult Wit� lender,or an pporney before
commenciK'k Work or ilecording your Notice of Commencement.
Vf L-4 Pti��
Signature olvowner/Ageit/Lessee Signature of Co-ritractor/License Holder
STATE OF FLORIQAJ.J STATE OF FLO!lr
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The forgoing Instrument was acknowieledit oreme The fo acknowledged
,Moing Instrument was i
is a day of F-Le t 20 by
nil M.-l'1+-o— A
(Name of person acknowledging) (N e of person acknowledging)
�Llaa' - - '7;-� 7— - e I
�L 1=214.p rcu I 1&q:�Qe -0
Nignature of Itary Public-State of tPeide)J (Signature of Ni ate of Flqiaii
Personally Known OR Produced identification
Personally Known�, Z_OR Produced identification
Type of Identification Produced Type of Identification Produced
Commis . 14 (Se,IJ Commission Not F
N, ASHLEY NICOLE ZIEGENGEIST
k My COMMISSION#FF1 . 712 ' 1-,! MY COMMISSION#FF1 20712
ReviSed07 EXPIRES May 7, is Z'� EXPIRES May 7, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
R—CEI ED
DATE
COMPLETED