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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a Permit Number:
RECEIVED JAN 2 4 a�i7
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.
Address: /0(�00 ��S eal'7� _Ep X41- 1010
Legal Description: �(C�GLi�Gl UULi7i ('jrL�Oi'Y)�nlUr'�'1
Property Tax ID#: 45// - 611 -0107- 000"g Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/DETAILED DESCRIPTION OF WORK:
A C Ghnog-e OcP] .(- CXO C;f Z. S J-on S — ��`�` � I/��(� UP N t T
CONSTRUCTION INFORMATION:
itiona work toeperformed under this permit-c hecka appy:
®HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
0Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction:$ I� Utilities:[]Sewer 0Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Name: hIIChGord QUI in307)
Address: 1 QCdnr ] # 1010 Company: 5-pwICe AYrQYiCCL
City: UeoC_h State: 4 J Address: Z7-'-S K)LO b3r`1 Ct
Zip Code:,3q-qG 7 Fax: city-.f4:'_ LC1l.cfer-�Gult? State:_F1
Phone No.0067-'707_. e5ff j Zip Code:3L3Z0q Fax: 95'1-q_n-, 5811
E-Mail: Phone No. 41l54 - _000
Fill in fee simple Title Holder on next page(if different E-Mail:-142errn G'Ct`weYICA.ccm
from the Owner listed above) State or County License: 'C AX 14&/q
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:
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 addition/'�'ntliial
accessory structures,swimming pools,fences,walls,signs,screen rooms aPment
uses to another non-res use
WARNING TO OWNER:Your failure to Record a Notice of Commay result in you� aying twice for
jble'iKthe
ments to your property. A Notice of Commencemento ed and listed on the jobsite
first inspection. If you intend to obtain financing, ca an attorney before
cing work or recording our Notice of Commenceme
s
Signk :, LesseeJContractor as.Agent_for Owner tSi ature of Contractor/License Holder]
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Thefoing instru ent was acknowledged before me The forgoing instru ent was acknowledged before me
�orP
this l�5 day of nUCI✓L' 20 q—by this Z3 day of )Q0(-JQr 20 L—L by
1' toV'Iosm (evit3SO17
(Nam of p ronacknb ledging) (N e o e on ac nowledging)
Z(Seatu�eootary P blic-State of Florida) (Sign ur of Not ry Public-State of Floridawn X OR Produced Identification Personally Known OR Produced Identification
Type of Identification r Type of Identification ro
o�' � � o�P , e� Sheneka Hardy
Commission No. _ NotaryC�ba`G-state oiFlorida Commission No. r ° NotaryF5!100stateofFlorida
Com issi n#GG33870 N� oc Commission#GG 33870
9reo=«o�` Expires 9/27/2020 9rro:Elo�� Expire.-
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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