HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I 1 G Permit Number:
S J _
•
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
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description: �� r2�(� I°�NIKK r T
Property Tax ID #:,
Site Plan Name:
Project Name: C' l acee_ -lP
Setbacks Front Back: Right Side
DETAILED DESCRIPTION OF WORK:
l c_ S�� s�
Left Side:
Residential ✓"
Lot No. [c.)9
Block No.
J5- --r e, I[ ) P5�
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit — check all that apply:
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
11 Electric Plumbing LJ Sprinklers U Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ `� %• � Utilities: Sewer 7Septic Building Height:
OWNER/LESSEE:
f►-���
Name NL.tmawun end_ IJ,,AeeA S'WrnelP
Address: _71 <°aciaj'e brE'L*
City: F'Gr1f— S1 ,t,LL.t'� State: FL
Zip Code: _�LPTRC-0 Fax:
Phone No.___5i Ct_'2p4Q
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: MICHAEL EWING
Company: PIONEER COOLING 8 HEATING
Address: 585 NW MERCANTILE PLACE # 106
City: PORT ST LUCIE State: FL
Zip Code: 34986 Fax:
Phone No. 772-579-9209
E -Mail: pioneerheatingco@bellsouth.net
State or County License: CAC1817251
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 your Notice of Commencement.
x
Signature of Owner/ ent/ LesLi.
STATE OF FLOTt1 A
COUNTY OF�. �
The for ing instrumen w acknowled ed before me
this ��day of �'C�� 20M by
M% i � I
(Name of person acknowledging
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. DE994N RUSSELL
o�
T
° Notary PublicState of Florida
l,omnnsarun a rr S 1630
Revised07/1'°c,4``, My Comm Expires Nov 30. 2018
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
�( '�f'
Signature of Contractor/ ense Holder
STATE OF FLORID
COUNTY OF 'IS+ . Wcli,�___
The forgoing instrument was acknowledged before me
this 11T,day of20®by
(Name of person acknowledging)
u
(Signature of Notary Public- State of Florida )
Personally Known 1/ OR Produced Identification
Type of Identification Produced
Commission No. .•`": �''�,6Jfllg*M RUSSELL
�= Notary Public State of Florida
• ' = #r FF 179630
0,F o?' vv Comm Expires Nov 30. 2018
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
1.