HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED
Date: QA kG Permit Number:
RECEIV"7-D FEB 16 2016
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)462-15.78 CCoTTercial Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED LMPROVEMENT LOCATIO1N
Address: g Ja� c �t-r cxk -t1 P P1
Legal Description
Property Tax ID#: 53Q-7—15E>�5p�3� OOO Lot No.
Site Plan Name: . Block No.
Project Name: 41
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
1''
CONSTRrUCTION INFORMATION:
Aciditional Work toa a orme apply:
un under ispermit—c ec a .,y
.. r."..
0
T
0NVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
OElectric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: (Ch S .Ft.of First Floor:
Cost of Construction:$L} 00.C Utilities:�Sewer ElSeptic Building Height:
O.INNER/LESSEE CONTRACTOR ,
Name rName: TODD DEJARNETTE
Address: q P1 Company: GX AIR CONDITIONING
City:�0�� cS'-� 1_e12C,c State:FL Address: 1401 SW MEDINA AVE
Zip Code: 6Lt4L' U Fax: City: PORT ST.LUCIE State:FL
Phone No. SOQ— L4t 9 'Z p Zip Code: 34953 Fax: .
E-Mail: Phone No. 772-344-5520
Fill in fee simple Title Holder on next page(if different E-Mail: 9xairheat@yahoo.com
from the Owner listed above) State or County License: CAC1814487
If value of construction is$2500 or-more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTI4N LIEN LAW INFORMATION"
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.,
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:
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 conflictwith 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.
� e
rgnature of Owner/Age q1 Lessee Signature of Contractor/ icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S4 Um_t' e COUNTY OF SA' LL.Lci".
The forgoing instru ent was acknowledged before me The forgoing instrgment was acknowledged before me
this,)1,'t day of r= 20 jkby this lLg!tay of kakOAAaw 20—J&by
(Name of person acknowle ing) (Name of person acknowle ng)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known 1,OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
DEBORAH RUSSELL DEBH RUSSELL
.�`'Y�� d-State of Floridan Commission No. .``cPaY`�s''-, 4
Commission No. R </'%
Notary Notary
Pub a ate of Florida
Expires Nov 30,2018 b �r o Y
My Comm. p FF 178630 -•o' : My Comm.Expires Nov 30,2018
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x,91 ��IF OF F���`�,
Revised 07/15/2
, 4� �"'"'�, Bonded through National Notary Assn.
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS