HomeMy WebLinkAboutBuilding Permit Application 11/9/2016 7 : 30 AM FROM: 7722063146 TO: +17724621578 P. 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date: Permit Number:
a 0 9 20?5
Building Permit Applicati®n
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-15S3 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
PROPOSED.IMPROVEMENT LOCATION:
Address: (Q
Legal Description:01ear t f X14.
Property Tax ID#: Lot No.
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 performed under t is permit-check a appy:
�Jk -IVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor.
Cost of Construction.$_� ��1,C�C� Utilities: Sewer Septic Building Height:
OWNER/LESSEE, CONTRACTOR:.
Name �1 Name: Ir
Address.�C�� CCRI r 0A_ Company` C Sla r�;K'
City: {� C,1A-1 Y( tR State: Address: ��o( �'�o� r �,a
Zi Code:�� _`
City: � �{-. � _ P State
Phone No.-71- 9 _(4-)Una Zip Code::r��
E-Mail: Phone No -53`l- (p[�
Fill in fee simple Title Holder on next page(if different E-Mail: &a c, to
from the Owner listed above) State or County License:
If value of construction is$2500 Wmore,a RECORDED Notice of Commencement is required.
11/9/2016 7:30 AM FROM: 7722063146 TO: +17724621578 P. 3
-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 TITLEHOLDER: Not Applicable BONDING COMPANY: X_ Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 anti 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
WARNIKIG 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
commendwfk _[e
_ _oi
.-_Q �cprding your Notice of CommencemenV
-DR
Signature of Owner/Lessee/Contractor as Agent for Owner Si nature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF. I
The forgoing instrurnent was acknowledged before me The forgoing instrument was acknowledged before me
this_day of 20 by this 9 day of NNMVY>tir 20 _14� % by
Crn
(Name of person acknowledging) (Name of person acknowledging)
(Signature A Notary Public-State of Florida) (Signature Notary Public-State of Florida
Personally Known X OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. `'t mmissicinNci.ff�- .Wio K&a . Florida
��y-]a stoto
Notafy b9c Stata of F"n
5j' '. Bailey Je
Bailey Jean Whittemore an Mittemofe
g my Ceinrntosim FF 998246
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Revised 07/15/2014
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