HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE 1NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.
Permit Number,. O
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u�ld � Permit , -pp 11catior�
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Planning.and DeveiopmenfServrces:
Building and Code•Reguiotion Division
2300 Virginia Avenge,Fort Pieru F..L 34992:
Ptione:::(772)462-1553 Fax (772)462=1578` Commercial. :. Residential
PERMIT"APPLICATI ON FOR; Mechanical
PROPOSED INPR01/E1//IENT LOCATION:
Address.
Legal Description. �. �i �S
PCopertyTax lD#:;='� 1q co CUC = Lot No
Site Plan Name. Block;No
Pr Fp
Setbacks` Front $a.ck Right Side Left Side
i U(illy
im
DETAILED DESCRIPTION-UF WORK
S 5e C oC
COI STRUCTIO.IV INFQR6VIATlON
ltiona mor to a orme un er t is permit E ec a_ app y
HVAC Gas Tank Gas.Piping Shutters: Windows/Doors
.,.. — El
Electric. ❑PI rTibing Sprinklers Generator Roof
Total Sq Ftiof Construction_ fk 5 Ft:of.Frrst Floor
Cost,.of Construction $ rte. C� Utilities Sewer Septic: Budding Height
EE
Name:
CONTRACTOR
Name Name: JOHN:BROVI)NIIVG
Address `rd � CcL Company JB''S AC&.ELECTRIC
GtyOf� i C `�' State P `_ Address: 1535;NW:QUAIL C!R
Zip Code.' 9Fax. City STUART State FL
Phone No Gi r>.( P Z' Zip Code 34994 Fax
E IVlail. Phone No. 772=934-6778
Fill qn fee Simpie Title Holder on next page(if different E-Mail jbrowninga, gmad cam
from the Owner isted above) State or countji License: CAC18163.19 ffetCal
If Vetue'of consteuction is$2500 or More.a RECORDfD.NoticQ of Cgmmen'cement:is requicetl
"SUPPLEMENTAL"CON LIEN LAW INFORMATION z
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: Stater
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:• _Not Applicable BONDING COMPANY: iNot 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 holderto build the subject structure
which is In conflict with any applicable Home Owers 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
commencinp,work or recording our Notice of Comm encementr7
}� ✓`(v s,
Signature of ovine - gent/Lessee Signature of Contr t cen ' Holder
�.i
STATE OF FLORID ��'"J ATE OF FLORIDA
"COUNTY OF �_ L-Le- }.P COUNTY OF �� t? z c� C
The fo oing instrumenXgas acknowled ed before me The forgoing instru ent was acknowledged before me
this ?lay of )�
20 by this l��ay of 20by
r
(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 OR Produced Identification
Type,of Identification Produced Type of Identification'
�.• "� "'•a DEBORAH RUSSELL
Commission No. a...0 (gg ''ll Commission No. ���s Nota6c-State of Florida
O��ORAH RUSSELL
Notary Publlc State of Florida Commission x FF 179630
xpif Ps Noy 0 2018
Commission
Revised 07/15/20 �'��,,, �; A� My Comm.Expires Nov 30.2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
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