HomeMy WebLinkAbout1603-0487ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
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
I' PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: -�-�
Address: gto.yrU��,1�, �J�2ly-� 4 .�d Z
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Legal Description:
Property Tax ID #: �4 - 60 0o 10 00c) '0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front__ _ Back-- - _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Addition wor to ei___r orme under this permit - check a apply:
VAC Gas Tank
tiE]Gas Piping _ Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator ❑ Roof
Total Sq. Ft of Construction:
Cost of Construction: $(Q.l�
S Ft. of First Floor: _
Utilities:L Sewer Septic
Building Height.
OWNER/LESSEE:
CONTRACTOR:
Name WA Lz 1eKzk-
Name: _�j2rt'�PJ�
Company: M \ I z✓
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Address:0/ S I1(
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City: �T U State: i"_ t
Zip Code: 3�C�� Fax:
Phone No. �) % X — �d - �
Address: %
City:'Ali,
Zip Code: 4
Phone No.
E -Mail: Ni)(blIG(
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Fax:
29-2c*b
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State: -PI
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E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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State or County License: C'A-L d t;72
& 7 S
Ivawc Vwllauut,uUn 15 .)43UV ur rnvre, a mm-uKutu rvornce or commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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
commerycing wv�rJ or recprding your Notice of Commencemerxt`. u
/ Lessee/Agent
STATE OF FLORI
COUNTY OF v Loc t --t
The forgoing instrument was acknowledged before me
this 2S__ day of W a,' C-1,-- 20 (Lby
(fie Vn r ILZ -�'_
(Name of person acknowledAi )
.1) �
(Signature of to
r-{-� ;R�p NORMA J STACK
P ,
ona�ly�n ?°toc�l9EltiPwititifStuMiotflorida
T e-of-rdentificatio R' Myr Comm. Expires May 5, 2017
as on
Commission No. honalNobiryAssn
Revised 07/15/2014
er
STATE Ot FLORI A
COUNTY OF_4 L -Lk ('
The forgoing instrument was acknowledged before me
this; day of ky\61LriCF , 20 '(✓ by
(Name of person ac
(Signatu
TYP-e--of Identificatio
Commission No.
State of Florida )
id u ced 110epli 04ii�
Notary Public • Stata of Fkwida
My Comm. Expiry May 5, 2017
Commie EE 864200
Wrim Th,"p WMWMIYry bsn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
Oct 14 2016 6: 19PM HP LASERJET FAXMILLERS CA 17723446480 page
PLANNING ANDDEVELOPNIENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
E FORT PIERCE,FL 34982
(772)'462-1553 Fax M2)462-1579
-7
D
CT I k 2016 PERMIT RENEWAL REQUEST
PERIAITTING
St Lucie County, FL
pF
,RMUNUMBEp. SLC 1603-0487ADDRESS: 9600 S.Ocean Drive,Jensen Beach,FL 34957
L Frederick D. Miller am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be flinded. Further,I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection durino any six month period during the renewal period.
Justification HVAC Chongeout LIKE for LIKE 3 TON, 14.50SEER 8 KW
October 14, 2016
(—O� LDR OR.CON CTOR SIGNATURE DATE
Frederick D. Miller
Print Name
STATE OF FLORIDA
COUNTY OF St.wde
ACKNOWLEDGED BEFORETM 14 DAY OF October .2016
,y Frederick D. Millert WHO IS PIMSONALLY KNOVN TO ME X OR
HAS PROVIDED AS IDENTIFICATION,
S ty() St. Lucie line NUAMAJ�$TAU
Notary Pubi,c-State of Floirldit.
MY Comm,Expires may 6,-9017
Commission#EE 864900
fill "'el T-i"Jugh National NotaryAssiL
SIGNAYME O�� Bor.
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total inspections:
(Divide open by total to get% f open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example. [15 divided by 23-:.65(1/o)) $175(permit fee)x.65=$113.75(renewal fee)
Revised 7t2112014