HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater -O) b Permit Number:
•
ire
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V/
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVEMENT LOCATION:
Address: 4'1D �4 (3Uo�` � zy—
/
y
Legal Description�2)Q Gt�,�r 1'A v 1'� IT. 1 L642S
Property Tax ID #: — Q — — Lot No. I
Site Plan Name: 7:�a eye' Its` ih Block No.
Project Name: C -C 1 V4 \
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Q l 1�
[CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit —check all that apply:
�✓ HVAC Gas Tank E]Gas Piping 1:1Shutters Windows/Doors
Electric Plumbing Sprinklers F_ Generator Roof
Total Sq. Ft of Construction: �-7 L° Sq. Ft. of First Floor:
Cost of Construction: $ r)-4 Utilities: []Sewer Septic Building Height:
C W N ER/LESSEE:
CONTRACTOR:
NamZ5` — ' ► ` ' /
Name: DOUGLAS PENCE
Company: ABSOLUTELY COOL AIR CONDITIONING �
Address: 4'tG �Oti c 1(%L \J �t6t�!
City:_—�->C� s�" c� State:F�
Address: 2311 NE 15TH COURT
Zip Code: C,5 Fax:
City: JENSEN BEACH State: FL
Phone No. '2 i q?1zP
Zip Code: 34957 Fax:
.�j,
E -Mail (�}x� l TLt ins Q U kcS- 0�m
Phone No. 772-475-4641
Fill in fee simple Title Holder on next page (if different
E -Mail: absolutelycoolair@gmail.com
from the Owner listed above)
State or County License: CAC1815702 _Z?, J50CU
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ILI
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
I Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ` Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
UwrvtK/ WN 1 KAL 1 UH 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
unty
es no
on
ranting a
t will
which is nc conflict with any pplicableiHo ethat
Owners Association irules, bylaws or and covenants that may restrict osubject
rr prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
to 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 I r paying twice for
,A
improvements to your property -Notice of Commencement must be recorded d pos d on the Jobsite
before the first inspecti6n. If yo intend to obtain financing, consul,th lender or an a rney before
comme�ig wor� or jecordir our Notice of Commencement.,-� ,/ /
nature CArWner/ Agent/ Lessee
nature of;Zbntractor/License Holder
STATE OF FLORI A STATE OF FLORID
COUNTY OF '+ ( COUNTY OF
The for Ing instrument was acknowied ed before me
thisday of 2011U by
(Name of persdnJacknow ledging )
#Signature of Notary Public- State of Florida )
Personally Known ✓ OR Produced identification
Type of Identification Produced
The for oing instrument was acknowledged before me
thi day of - C;0�3 jy , 205D by
(Name of per§d acknowledging j
7
(Signature of Notary Public- State of Florida )
Personally Known ✓ OR Produced identification
Type of Identification Produced
Commis„ Commission No .....n„ I
40 v""� ;; - - pEB6RAH RUSSE@L `i►*• ''�.�- OEBOUSSELL
� �••: Notary Public State of Florida
RJt
� �
¢". Notary Public •State of Florida
Commission -1796W-- M - •-
ReNise 'OF r� •#Ay Comm. Expires Nov 30, 2018 ':'� My Comm Expires Nov 30. 2018
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