HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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 x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION.
Address: o I�
Legal Description: Sheraton Plaza-unit three replatlot 211 (or 1102-612
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Property Tax ID#: 1432-806-0079-000-8 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
Install hvac split system 2.5 ton /16 seer110 kw Like for Like
CONSTRUCTION INFORMATION:
Additional worK to De per orme un er t is permit—c ec I a app y:
ZHVAC Gas Tank OGas Piping _Shutters windows/Doors
FlElectric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SQ. Ft. of First Floor:
Cost of Construction: $ 3850.00 Utilities: Sewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name �� t�rc ,-� Name: r. R ;✓2
Address: ' C> 7 �S. Company: AIC Express & Heating LLC
City: . . State:FI_ Address:
Fax: Y�
Zip Code:
34946 City: ,.S State:Fl
_
Phone No.772-708-6516 Zip Code: 34983 Fax:
E-Mail: Phone No. 7722404857
Fill in fee simple Title Holder on next page{if different E-Mail: acexpress2@gmail.com
from the Owner listed above) State or County License: caco57139
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAVA 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:
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 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 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 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
commencing w k or recording our Notice of Commencement.
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Signature Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'r. 1� �� , COUNTY OF . Lt1f C�/
The forgoing instru nt was acknowledged before me The for Ding instr ent was acknowledged before me
this day of S� 2 by this day of S i` 20� by
e of berson making statement Na4me of i1erson making statement
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced -C) - Produced
Signa ure of Notary Public-State-Qf Fidriha --': - �-- u a of Notary Public-State pf Florida)
f ��` LAJRA hflANN =- 3
Commission No. �`+ (Q n 0 I}}Notary Public-State E orlda w sion No ����� `' I LAl1RA MAfV
s � ? `Ay Comm.Ex®fires Apr o '�°� �I i nary Public-Slate of lorida
Commission# FF 0 4692 %v,; - _ tvsy Corrm.Ex Tres A P
9„;"' Bonded ihroughNationalN LaryAssn.� 1 -_° ��¢ Commission �FFP 9 92 1
-A — �rouyh National ei Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE ' MAWGRC?VI
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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