HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: Permit Number: 10 1 •����
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: Mechanical
PROPOSED IMPROVEMENT LOCATION: 1' ,, _j�"
Address: 3520 RED TAILED HAWK DRIVE
Legal Description.. FAIRWAYS AT SAVANNA CLUB REPLAT NO. 1 (PB 57-40) BL'K 70 LOT 20(OR 2950-1698)
Property Tax ID#: 3424-800-0090-000-4 Lot No.20
Site Plan Name: Block No. 70
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
A/C CHANGE OUT
4 TON
14 SEER
10 KW
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC Ei Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing 11 Sprinklers El Generator El Roof Roof pitch
Total Sq. Ft of Construction: 1,741 S . Ft. of First Floor:
Cost of Construction:$ 6300.00 Utilities.
CnSewer Septic i' Building Height:
OWNER/LESSEE: CONTRACTOR�W,771'11ff
Name ADOLPH KOERNER Name: MARK A VINES I,
Address:3520 RED TAILED HAWK DRIVE Company: AZTIL
City: PORT ST LUCIE State: FL Address: 2540 S MILITARY TRAIL
Zip Code: 34952 Fax: City: WEST PALM BEACH State:FL
Phone No. 772-607-3742 Zip Code: 33415 Fax:
E-Mail: Phone No. 561-433-2197,,
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@AZTILAC.COM
from the Owner listed above) State or County License:!CAC049253
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required
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SIUiPPLEMENTA;L'CONSTRUCTION LIEN LAW IINFORMATl)0,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
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Name:ADOLPH KOERNER Name:MARK AVINES
Address:3520 RED TAILED HAWK DRIVE Address: 3520 RED TAILED HAWK DRIVE
City: PORT ST LUCIE State: City: WEST PALM BEACH State:
Zip: Phone Zip: iPhone:,
FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:2540 S MILITARY TRAIL 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 r property. A Notice of Commencement must be re'corded,and posted on the jobsite
before the fir ns ction. If you intend to obtain financing, consul I lender or an attorney before
commenci wor o recording our N ce of Commencement.
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Signature of Owner/Lessee/ ontractor as Agent for Owner Signat re of ContrAtor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 27 day of SEPTEMBER 20 Ol by this 27 day of SEPTEMBER 2017 by
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Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
71 1
(Si ture of tary - .S 3 I fe o CIF�O�D
"e MY COMMISSION#FF077427 '
MY COMMISSION FF077427
oQ EXPIRE ember 17,201 `= o= c�op 11
Commis n '•'�oF� .. Com Issio 0. IBES Dec�F7su� t 17,2017
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(407)398-0153 FloridallotaryService. (407)398'-0153 FloridallotaryService.com
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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