HomeMy WebLinkAboutBuilding Permit Application Nov 09 1701:39p 772-336-9032 772-336-9032 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 Permit Number:
Building Permit Application NOV 0 9 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential Xx
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 7965 Saddlebrook Drive, Port St.Lucie
Legal Description: SABAL CREEK-PHASE IV-LOT 166 (OR 1708-66)
Property Tax ID tl: 3328-701-0019-000-4 Lot No. 166
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace existing a/c equipment with a Rheem 2.0 ton 15.5 SEER Heat Pump, with 5kw aux. heat
(Replacing 1 of 5 systems) RP1524BJ1 Condenser, RH1T2417STANJ Air Handler
CONSTRUCTION INFORMATION:
Additional work to be Derformed under this permit—check a appy:
HVAC Gas Tank E]"as Piping _Shutters Q WindowsJDoors
FlElectric F] Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 4250.00 Utilities:Cn Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Debra Wirike Morris Name: Jacques C.Stiegelman
Address: 7965 Saddlebrook Drive Company: Jack Frost AC of South Florida, Inc.
City: Port St. Lucie State: FL Address: 1716 SW Biltmore St.
Zip Code: 34986 Fax: City: Port St. Lucie State: FL
Phone No. 772-971-0603 Zip Code: 34984 Fax: (772)336-9032
E-Mail: Phone No. (772)336-9030
Fill in fee simple Title Holder on next page(if different E-Mail: JACKFROSTFLORIDAOAOL.COM
from the Owner listed above) State or County License: CAC 1815725 1 Cc.25113
I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Nov 09 17 01:40p 772-336-9032 772-336-9032 p.3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
_ I
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 work or recording our Notice of Commencement.
A.
Signatu of Owner/Agent/Lessee Signatureroftractor/License Holder
ST OF FLORIDA STATEIDA
COUNTY OF St_ Lucie COUNTY OF St. Lucie
The ing instrum nt was acknowled ed before me The f ging instru nt was acknowledged before me
this day of 0 Qf17 ,v—r 20 1�by this�day of AI DL;"1 4k.t' ,20 LL�' by
Jacques C. Sliegelman, Jacques C. Stie elman
(Name f person ackno ging) (Name o person acknb dg g
nature of Notary Public-State of Florida) ( ature of Notary Public-State of Florida)
Personally Known XX OR Produced Identification N/A Personally Known XX OR Produced Identification NIA
Type of Identification Produced '',, Type of Identification Produced
Commission No:�(a' OQ0%3�o K�s��R parsons Commission No.G& OQD93tp (Seal)
NOTARY PUBLIC � Kristina R.Parsons
STA-ftIDA wr)TARY PUBLIC
STATE OF FLORIDA
Revised 07/15/2014Cor"rr`#GGM36 comrn#GG09W36
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