HomeMy WebLinkAboutBuilding Permit Application 7J /a'G
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTS
Date: Permit Number:
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 Residential ✓
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION: 4{
Address:
Legal Description: eat
I
Property Tax ID#: 3 35 rJGJ. w(O-1 — 000"— 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: '
-_ J
A0 dla. )3e Oul Z•5 tDns m 15 Seer •�..' �/
CON STRUCTIGN, INFORMATION: f Sq, f
Additional work toe e orme under t —checkispermit a appy:
HVAC Ei Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ElPlumbingSprinklers E Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of FirstftrjCost of Construction:$ t�8� Utilities:�SewerSptic Building Height:
OWNER/LESSEE: CONTRACTOR.
Name Qf_L nr) nr-in Name: iCV01 ra eV i V1 SQ h
Address:614alQ r 0470f? Company: Service (Yle-v lCQ
City: �t')SG�Y1 State:_ Address: Z165IN�(-JIJ�,(tO3yd (Ii' G
Zip Codec=�1"�5 1 Fax: City:� L0uCff P C}_,1u.V_ State: T
Phone No.7_70—�—g20cl Zip Code: Fax:
E-Mai1:111a "Q47 CO(-nPhone No.Q glq' )( O Ext 656_13
Fill in fee simple Title Holder on next page (if different E-Mail:tWmts VICe(grnexi(7l coty
from the Owner listed above) State or County License: (q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-SUPPLEMENTAL.CONSTRUCTIO.N..LIEN'LAw INFORMATION.;„�
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ,R _Not Applicable
Name: Name: I'
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: I'
Zip: Phone: Zip: Phone:
I
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 f I concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms a ccessory uses to another non-residential use
tbr
Aen
NER:Your failure to Record a Notice of Comm nc m ma result in your paying twice for
your property. A Notice of Commencement u t e co ded and posted on the jobsitespection. If you intend to obtain financing, c ns I wit I nder or an attorney before
k or recording our Notice of Commenceme
s
Sign aturew r/L ee/Contractor as Agent for Owner Signature f ontr to'r/License Holder
STATE OF FLORIDA ��� f STATE OF FLORIDA /J
COUNTY OF W COUNTY OF ,�/IUI,�I f /
The 71goday
ling instrument w s acknowledg before me The forgoing instrument was acknowledged before me
this of 20i�by this�day of_ 1 W✓ l 20 4 by
L i llnard �n eac.4 Z”"S"
(Name of person acknowledging) I/(/r (Name of person acknowledging)
J)qNL, d4(�
c�L �IIvVVAAd""'/MMMiv/ll
(Sign'gti.Yre of Notaublic-State of Flo r da) (Si ature of ary Public -Stat of FloridaV )
Personally Known. OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. SHERIFA Y Commission No. Y"�py'., � WHyrE
OMMISSION q FF65032 MY COMMISSION#FF 065032
EXPIRES:October 21,2017 ;; EXPIRES:October 21,2017
ThFu PietaFy Pu lie Unde t.de ruo ary u lCUnde v.iters
Revised 07/15/2014
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DATE
COMPLETE
INITIALS
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