HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO VUST BE-COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 -/Z)7_. Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services NAR 15 2016 -
Building and Code Regulation Division
2.300 Virginia Avenue,Fort Pierce Ft 34982 '11�
Phone.(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PR POSED:.I.N.PRP,VEMENT LOCATION".:
Address: Jk\� Y-1- \Q-
Legal Description:Pjj��-JkjL VN-L<11
Property Tax ID Lot No.
Site Plan Name- Block No.
Project Name-- n _0-A--Jr(2k-
Setbacks Front Back: Right Side: Left Side:
;DETAILED DESCRIPTION Q'P.'WORK--
45;-� A
CON$TRUC7[..b'.N,'.,-IN'FORM.A-,T�IOIN::,
Adciltionalwar KtobnGas
rtormed under this permit-cheCK all tm apply:
IZHVAC Tank F]Gas Piping 1 —1 Shutters F]Windows/Doors
O'Electric 0 Plumbing' F15prinklers FIGeneratorF�-Roof
Total Sq.Ft of Constructiow. S . of First Floor:
11 SewerF]Septic Building Height:
Cost of Construct-ton:$ Utilities..
OWNER/LESSEE! CONTRACTOR:
RACTOR
Name: THEODORE MANN
Address,5��0 Company: AC MANN INC
City: M ocny C State.;flk 0�'�Address: 1050 SW BILTMORE STREET
Zip Code:'FHM-'LO Fax: City: PORT ST LUCIE State:FL
Phone No. 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@aol.com
from the Owner fisted.above} State or County License: CAC1814425
If value construction is$2500 or more,a RECORDED Notice of Commencement is required.
t
��MEM, NTAE S'TINFORMATION. S} i5
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 the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or ancovenants 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 your Notice of Commencement.
Signature df Owner/Agent/Lessee SignatureKof Con-tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S+' / COUNTY OF 'S+-,t1"j!j6!_
The for .ng instrumignt was acknowledged before me The forgoing instrument was acknowledged before me
this��Xayof ffiAAP-,h 20TI G by this ict**day of MQ 20[_U by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida
Personally Known *.,/ OR Produced Identification Personally Known %'X OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. CommissionN
DE RUSSELLDEBORAP4865WI-L
of Florida 11,
o�Pay P i Florida
State o Notary Public-State Notary Public
MAP, m,rnmm-Expires Nov 30,201
My Comm.rAp", Go 'F 11,9b"
Commission#
'I No
Commission i Notary A,,,.'
Revised 07/15/
......... Bonded through Nation
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DATE
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DATE
COMPLETE