HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 110-,-R 1 ! co Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓/
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVEEM`ENT LOCATION:
Address:. ( '1X1 gni On
Legal Description:—YC,�D 3 Gc.`i''- p i*q�J2 P",4 1 !t
P�
Property Tax ID #: 3o'5 ti{" — i ax., cc ->o Lot No. l �'
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be Dertormed under this permit —check allfl
apply:
✓HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
U Electric Plumbing 11 Sprinklers I Generator ❑ Roof
Total Sq. Ft of Construction: qC� Sq. Ft. of First Floor:
Cost of Construction: $ ,3%S�D•ac-) Utilities: I I Sewer D Septic Building Height:
OWNER/LESSEE:
Name _ Q IY�i rQ Lt )h-41 � PfT
Address:r73G AK 0_1"'7-)r-
City:
1"'7-)rCity: �Vr1 (-Wks State: P241'-_
Zip Code: Fax: '
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: DOUGLAS PENCE
Company: ABSOLUTELY COOL AIR CONDITIONING
Address: 2311 NE 15TH COURT
City: JENSEN BEACH State: FL
Zip Code: 34957 Fax:
Phone No. 772-475-4641
E -Mail: absolutelycoolair@gmaii.com
State or County License: CAC1815702
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATiO
DESIGNER/ENGINEER:
_ Not Applicable MORTGAGE COMPANY- = Not Applicable
Names
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 thepermit holder to build the subject structure
which is in contlict 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 I r paying twice for
improvements to your pr . Notice of Commencement must be recorded afid pos d on the jobsite
before the first inspeIf yo Intend to obtain financing, consu�yw�ih lender or an at rney before
comm g woo or Crecordi.-C your Notice of Commencement /
�ignature wner/ Agent/ Lessee ignature of 77 6ntractor/ enSe Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �-� 1rLll�iE COUNTY OF S4—
The
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The forgoing rnstru�qpent was acknowledged before me
thiYa�'A day of N0_LC t�, 20ECJ by
(Name of persJacknowledging )
(Signature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
The fojrgcyng instrurpent was acknowledged before me
this,ay of, /VC7_,-C �4 /L_ , 20[Zlby
LA -t14 —RnCc_
(Name of person knowledging )
(Signature of Notary Public-- State of Florida )
Personally Known ✓ OR Produced identification
Type of Identification Produced
Commission No Commission No
DEBORAH RUSSELL iJvi
DEBORAH RUSSELL
fvbtie—StateeI fleii9a- t•'_ �„ Florida —
i� Commission #r FF 179630
Revised 07/1 / a� Commission #r FF 179630
a' My Comm Expires Nov 30, 2018 •.,',EMy Comm. Expires Nov 30, 2018
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REVIEWS FRONT ZONING I SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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