HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO-MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit NumberJE
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division _ 1�� ^
2300 Virginia Avenue,Fort Pierce FL 34982 nd o
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED.INPROVEMENT LOCATION.
Address: i-l- C> p 9
Legal Description: �Q f�G -b��Cr'f V 1 `�Q� /� p�oJtpr tc-7 Ci � (h - U nr-
Property'Tax ID#: Qb 5 ' tO4,o-p L0o Lot No.
Site Plan Name: Block No.
Project Name: !?to .
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF,UVORK
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P are I� O 5.
CONSTRUCTION INFORMAT_ ION
Additional work toe ertormed unciertnis permit—c ec aI that appy:
12]HVAC Gas Tank ❑Gas Piping Shutters E]Windows/Doors
_
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/LESS E;E CONTRALTO R
Name rIl Name: MICHAEL EWING
Address:_541 3 fr &� (—C- _ Company: PIONEER COOLING&HEATING
City: State: Address: 585 NW MERCANTILE PLACE# 106
Zip Code: LR>4 P Fax: City. PORT ST LUCIE State:FL
Phone No. L Q21_�- q 1.3 3 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: CAC1817251
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN L'A1tU INFORMATLON _
y
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.
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 holderto 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 of Owner/ ent/Lessee Signature of Contractor/U ense Holder
STATE OF FUM2'
STATE OF FLORID
COUNTY OF �' "- `� COUNTY OF
The forgoing instrument was acknowled ed before me The for irig instryy��vnent was acknowledged before me
this 'day of 20UIBJ by thisSr 20Mby
(Name of person acknowledging) (Name of person acknowledging
(Signature of(Votary Public-Stat of Florida) (Signature of Notary Public-State of Florida.)
Personally Known_ OR Produced Identification Personally Known t-- bl .OR Produced Identification
Type;of Identification Produced Type of Identification Produced.
..'`„av p� EBORAH RUSSELL
Commission No. -`sP e�°; Notarlic-State of Florida Commission No. Y
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_ o• My Comm.Expires Nov 30,2018. OE96L!�� # uolssiwwo�
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%°i� Bonded through National Notary Assn. epuolq to almsollgnd Iiie1oN
Revised 07/157204 113ssna Hv80e30
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE-
COMPLETE
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