HomeMy WebLinkAboutBuilding Permit Application ALL,APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and DevelopmenfServices
Building and Code Regulation Division
2.360 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)4624553 Fax:(772)462-3578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
,Ak POSED INPROW. ENT.LO,.CAT14N
Address: V
Legal Description~._� CR
Property Tax ID#;, Lot No. CEL
Site,Plan Name: Black No.
Project Name: Ma ii
Setbacks Front Back: Right Side: Left Side
DETAILED DESCRIPTION-OF WORK-
CQNSTRk1C1'ICJN'.1N1rORfV1ATt�N '_ :.:
Additional workto e e orme urider _isperrtit–c eca appy:
✓HVAC Gas Tank QGas Piping Shutters Q Windows/Doors
Electric MPlumbing ❑Sprinklers Generator Roof
Total Sq.Ft of Construction: ? .1.. S Ft,of First Floor:
Cost of Construction:$ 1 Utilities:Sewer Septic Building Height:
W, ER/LESSEE Ct3NTRACTOR
Nam e �aY"1 _LQ, Name.: THEODORE MANN
Address: -1 L�l_` YP.YY�-�C1r'� Company:.AC MANN INC
City:,% n-y_ .l l !res State:1517K VAddress: 1050 SW BILTMORE STREET
Zip.Code:tT-)C_1 U Fax: — City: PORT ST LUCIE State:FL
Phone No.-~-1 --`js2- '-SSS Zip Code: 34983 Fax:
E-Mail:,-_" Phone No. 772-340-4604
Fill In fee simple Title Holder on next page(if different E-Mail: psla.cmann@aot.com
from the Owner listed above) State or County License: CAC1814425
If value of construction is$2500 or more,a.RECORDED Notice of Commencement is required.
SUPPLEM-NT IX NSsTRUCTION LIEN LAVU'INFORMATION.
DESIGNER/ENGINEER: 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 County makes no representation that is granting a permit will authorize thepermit 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 recording our Notice of Commencement.
Signature 'f Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-t'- , C-LtCt'2 COUNTY OF Ob L-L-let,e
The for 56 instr ent was acknowledged before me The forgoing inst ent was acknowledged before me
thia9l day of 20W by this n!r day of 20®by
` ecce f►'� re fy1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida} (Signature of Notary Public-State of Florida}
Personally Known _ duced-Ideuti#icatio. Personally Known o✓ OR Produced Identification
Type of Identificatio rgdyd, DEBORAH RUSSELL Type of Identification Produced
y Public-State of Florida
Notary _
Commission No. =r *Q'My Con(SeM)pires Nov 30,2018 Commission oR Lry :""'RAH RUS aQ
commission#FF 179630 t" a
[� _a°„ 4`0: Notary Public-State of Florida
°
Bonded t ouoh atio a Notary ss F1 ' * - pos ✓
-;r , Commission#FF 179630
Revised 07/15/2014
%Ot� Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED