HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 411 1 1 1P Permit Number:
• RECEIVED
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Building Permit Application
Planning and Development Services ...APR
-11 2016
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residentiali
PERMITAPPLI CATION FOR: Mechanical
PROPOSED INPROUEMENT LOCgTION
Address: Q Do [ I)(ko
Legal Description: / .� Q+— P6 Q V l (l 4�
Property Tax ID#: _J��J`T �7O[ rjL Og`� tj( j�j� Lot No.���
Site Plan Name: Block No.
Project Name: O
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION:
Additional work.toe e Orme under this permitcheck a appy:
✓HVAC rlGasTank EJ Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers 11 Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of.Construction:$ QQ DO. Utilities: Sewer Septic Building Height:
SSE
ON
CONTRACTOR
Name f ' ,D Name: MICHAEL EWING
Address:'&ata AL�.+-�i Lr7 Company: PIONEER COOLING&HEATING
City: ��°�cb'� L�A��-H� Stater Address: 585 NW MERCANTILE PLACE#106
Zip Code: i L21 0-6 Fax: City: PORT ST LUCIE State:FL
Phone No. ���L ��! 9 Zip Code: 34986 Fax:
E-Mail: Phone No. 772-579-9209
Fill In fee simple Title Holder on next page(if different E-Mail: pioneerheatingco@bellsouth.net
from the Owner listed above) State or County License: CACI 817251
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-- 4I°
SUPP,L`EMENTAL CONSTRUCTION LIEN lAW INFORMATION ' 3 '
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 iii 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 of owner/ ent/Lessee Si nature of Contractor/U ense Holder
STATE'OF FL A STATE OF FLORID
COUNTY OF .Uc COUNTY OF
The forgoing instrument was acknowledged before me The for ing instrument was acknowledged before me
this L day of 20U by this LWday of 2099by
ICY)fi O'hi A Ll13 t na .. 1 I 1 `' e nq
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi tate of.Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known ��o R Produced Identification
Type of Identification Produced Type of Identification Produced n
Commission No. DIPRI RUSSELL Com iss YI1 DEBORAH RUSSELL
Notary u is State of Florida ovY 5��� o tate of Flc(SBa ).
_' ° ;•_My comm.Expires Nov 30,2018 2 " My Comm.Expires Nov 30,2018
rp 630
Revised 07/15/2 1 'e �� ` Bonded through National Notary Assn. '.;rFF�oo-c Bonded through National Notary Assn.
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