HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 �0 — l o 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5713 BALSAM DR
Legal Description: INDIAN RIVER ESTATES
Property Tax ID #: 3402-610-0338-000-4 Lot No. 12 & 13
Site Plan Name: Block No. 81
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
LIKE FOR LIKE A/C CHANGE OUT. NO DUCT WORK. 3 TON 14 SEER 8 KW
CONSTRUCTION INFORMATION:
Additional wor _tobe performed under this permit — check all that appy:
❑✓_ HVAC Gas Tank F]Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing 11 Sprinklers D Generator D Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 5039.00
S. of First Floor:
Utilities: Sewer E Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name SANDOR RIHOLM III
Name: JAMES DEGATINA
Address: 5713 BALSAM DR
Company: ALL AMERICAN AIR & ELECTRIC, INC
City: FORT PIERCE State: FL
Zip Code: 34982 Fax:
Phone No. 772-267-2460
Address: 611 NW MERCANTILE PL
City: PORT ST LUCIE State: FL
Zip Code: 34986 Fax: 772-878-5144
Phone No. 772-878-5143
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: GRUF@AAAAEINC.COM
State or County License: CAC057965
If value of construction is 5z5oo or more, a KtLUKUtU IVOUce or LommencernenL a icyuICU.
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-Morne 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 twine for
improvements to your property, A Notice of Commencement m"- t 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 ,tour Notice of Commencement-
-__, �r
_
Sign at er/ Lesse /Agent
STATE OF FLORIDA
COUNTYOF �
The forgoing instrument was acknowledged before me
this day of _,yA014� 20 I rby
Name of person acknowledging
;Signature of Notary Public- State Iorida
Personally Known OR Produced Identification
Type of Identification Produced_
_GENA LORENZ RUF
Notary Publi-state of Flori
_Commission # FF 957967
My Comm, Expires Feb 7, 2-0
Sign on etor(License Fio�der
STATE OF FLORID
COUNTY OF_
The forgoing instrument was acknowledged before me
this ILPL day of _ 20 1
jt by
(Name of Person ocknowledging U
l.c.
,Signature of Notary PgWic- 5 f Florida i
Personally Known ^_x OR Produced Identification
Type of Identification Produced
Comrnission,No.
[it NA LORENTRUF
i .�4➢":1-_ Notary Public - State of F
My Comm. Expires Feb -7,-i;20
REVIEWS
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
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Not Applicable `
Name:
Name:
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Andress: -
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Address: �-~ --
State:
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City: _ State:City:
Zip: _. Phone:
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Zip. , Phone:
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IIFEE SIMPLE TITLE HOLDER:
� Not Applicable
BONDING COMPANY:
Not Applicable
Name.
_
I Name:
Address:
_
Address
City:
city: -40
Zip: _r 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-Morne 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 twine for
improvements to your property, A Notice of Commencement m"- t 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 ,tour Notice of Commencement-
-__, �r
_
Sign at er/ Lesse /Agent
STATE OF FLORIDA
COUNTYOF �
The forgoing instrument was acknowledged before me
this day of _,yA014� 20 I rby
Name of person acknowledging
;Signature of Notary Public- State Iorida
Personally Known OR Produced Identification
Type of Identification Produced_
_GENA LORENZ RUF
Notary Publi-state of Flori
_Commission # FF 957967
My Comm, Expires Feb 7, 2-0
Sign on etor(License Fio�der
STATE OF FLORID
COUNTY OF_
The forgoing instrument was acknowledged before me
this ILPL day of _ 20 1
jt by
(Name of Person ocknowledging U
l.c.
,Signature of Notary PgWic- 5 f Florida i
Personally Known ^_x OR Produced Identification
Type of Identification Produced
Comrnission,No.
[it NA LORENTRUF
i .�4➢":1-_ Notary Public - State of F
My Comm. Expires Feb -7,-i;20
REVIEWS
DATE
! FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
i SEA TURTLE
REVIEW
� MANGROVE i
REVIEW I
COMPLETE
j INITIALS��^
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