HomeMy WebLinkAboutBuilding Permit Application ALL.APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: PermitNumber: �a- ( �
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2306 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial _ Residential
PERMIT APPLICATION FOR: Mechanical
F.ROPQSED INPR OUEMENT LOCATION
Address-�,--2:), CY,�ZuCL__Q
Legal Description--kal n-XA�, i& 14 sfa\incn, Ai c,,>
Property Tax ID#;_54443- _ --nl�i CZ- - t--{ Lot No.
Site Plan Name: Block No.—I 4
Project Name: aI0 r ini c-)
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION
Additional work toe e orme under this permit-check a a appy:
✓HVAC ri Gas Tank Gas Piping Shutters Windows/Doors
11 Electric FlPlumbing [i
Sprinklers Generator Roof
Total Sq. Ft of Construction: R1=__1)1 Sq. Ft.of First Floor:
Cost of Construction:$,�y(QD Utilities:Sewer aSeptic Building Height:
OV1/NER%LESSEE CONTRACTOR
Na m6aC=MJn 4 10X2d(7Name: DOUGLAS PENCE
Address: 1: lam E�' �A Company: ABSOLUTELY COOL AIR CONDITIONING
City: 2C -e_Anl -2 - �0,VA State:FIL Address: 231 1' NE 15TH COURT
Zip Code:ZOLi Fax: City: JENSEN BEACH State:FL
Phone No.'l—t-Q). Zip Code: 34957 Fax:
E-Mail: Phone No. 772-4754641
Fill in fee simple Title Holder on next page(if different E-Mail: absolute(ycoolair@gmail.com
from the Owner listed above) State or County License: CAC1815702
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S,LPP�,EI�IESTAi:CCN�TRfii'lOtii LSI LA►VtI`ii�lFbRMAT1t3N: ' k u t
DESiGNERJENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State'
Zip: Phone: Zip: 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 Countymakes 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 Horne 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 plaits,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exemptfrom 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 i r paying twice for
improvements to your pr Notice of Commencement must be recorded d po d on the jobsite
before the first inspe n. if yo intend to obtain financing, consul 'th tender-or an a rney before
comm wor _or ecordi our Notice of Commencement.
r
tgnature ct. caner/Agent/Lessee %g—nature of ntractor/LiceAi Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF -:;J .L,"&e-
The forging instru nt was acknowledged before me The fordo g rostrum nt was acknowledged before me
thi day of_ � 20W by th- R ay of 20JIK;by
(Name of persacknowledging) {Name of pers acknowledging)
(Signature of Notary Public State of Florida} (Signature of Notary PubR tate of Florida}
Personally Known V OR Produced Identification Personally Known - OR Produced Identification
Type of Identification Produced Type of Identification Produced
^� = --
DEOR�H RUSSELL DEB0�t4SSELl
Commission No. �! "'Y Ti''1, Commission No. } °�
Notary UDR _State of Florida t F&
» Notary pub tc ate of Florida
ak�;•'My Comm.Expires Nov 30,2018 f ,�° _My Comm.Expires Nov 30,2018
t ,r9* n ¢,, commis )J.
* �: Commissi
"; 4�0; ationa!Notary Assn.
Revised 07/I5/ZD 141 °}F`�d Bonded through National Notary Assn. or FL,o Bonded through N
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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