HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Lo Permit Number:_
Building Permit Application AUG 0 3 2016
Planning and Development Services PEWV11TTi"r•;G
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT.LOCATION ,
Address: 4C)o O3
Legal Description UCeGa-fl dl a `Llt"S OnolDrnth i*u m
Property Tax I D#: J 5 35--?DeP- cDo I p - 0t)-Q Lot No.
Site Plan Name: Block No.
Project Name: 06 i hue*_
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION`OF WORK
cp men'- Q P 42 -roN 15 5s--f-
CONSTRUCTION INFORMATION
Additional work toa orme - under is perms -c ec a appy:
HVAC 11Gas Tank Gas Piping _Shutters Windows Doors
Electric 1:1 Plumbing FSprinklers LI Generator F]Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:-$ Utilities: Sewer Septic Building Height:
OWN ER/LESSf E CONTRACTOR
Name en 3 U r i'cL O Ci I Q Name: PATRICK FLETCHALL
Address: 4 U�'3 f� a, Il -7 11-) p 1 Company: COOL 8 RELIABLE AIR COND
City:- I"Qm�' State:FL Address: 1051 NE SANTA CRUZ DR
Zip Code: 3 1 Fax: City: JENSEN BEACH State:FL
Phone No. 1"�a� �Q��- 5-7 15i) Zip Code: 34957 Fax:
E-Mail: Phone No. 772-692-5750
Fill In fee simple Title Holder on next page(if different E-Mail: r cool@bellsouth.net
from the Owner listed above) State or County License: CAC058567
If value of construction is S2500 or more,a RECORDED Notice of Commencement is required.
SUpPLEMENTALCi)NSTRUCTION LEEN LAIN INFORMATION: : Y
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name-
Address: Address:
City: State• City State:
zip: Phone: TI p: 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 Coun "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,'sign's,screen rooms and accessory uses to another non-residential use
WARNING TO OWNERS 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
commencin work or recdrdine vour Notice of Commencement.
$ig re of Owner/Agen t/Lessee ature of Cant or icense Holder
•�;>! „°rte.
STATE OF FLORIDA STATE OF F RIDA
COUNTY OF LLICc '- COUNTY OF -f': L- -��e-
The forgoing instrument was cknowled ed before me The forging instrument was acknowledged before me
M
this day Of M �� 20by thi�day of ' . 26aby
(Name of person acknowle (Name of person acknowledging)
LCm H
gM
(Signature of Notary Pu lir State of Florida) .� "
(Signature of Notary Public-State of Florida} N o
o n
Persona) Known � OR Produced Identification c °i
Personally Known ✓ OR Produced identification IY
Type of Identification Produced Type of.ldentification Produced'
Commission No. .- ��`' R RUSSELL ommission No. (Seal)
Notuyvc-SWO off10 W
•_ Commbtfon•FF tiQ UO
Ii my Comm.Ex"Mawr am
Revised 071251 i4 M M f
REVIEWS FRONT" ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED