HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / O
Date: L ' VA � Permit Number:_AW 9 q�
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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 xx
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: `-. `:, l�%��t/1�11�1c
Legal Description:
tgProperty Tax I D#: 1"TZ I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
LIKE FOR LIKE AC CHANGEOUT - 1, 2 1/2 TON GOODMAN, 14 SEER, 8KW HEAT
CONSTRUCTION INFORMATION:
Additional work o be performed under this permit—check all appy:
ril
HVAC Gas Tank []Gas Piping _Shutters F]Windows/Doors
11Electric ❑ Plumbing Sprinklers F1 Generator �Roof Roof pitch
Total Sq. Ft of Construction: t �l S Ft.of First Floor:
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1
Cost of Construction:$ `'T2L_IJ Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Namet�lZA Li FCA E .?'1-t>" CL Name: Phil I L1') "'J i scl —
Address:� r L( lL(.;(11 L-L, Company: NISAIR AIR CONDITIONING
City+A} n' 1k;(ASS"C. State:GA Address: S1 h
Zip Code: 30546 Fax: City: 0—t Peru State:FL
Phone No.706-455-0971 Zip Code: 34962 Fax:
E-Mail: Phone No. 772-466-8115
Fill in fee simple Title Holder on next page(if different E-Mail: KRISTIN@NISAIR.COM
from the Owner listed above) State or County License: CAC041199
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:
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 a recorded and posted on the jobsite
before the firsk inspection. If you intend to obtain financing,consult with lender or an attorney before
commenc.inR work or recording our Notice of Commencement.
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Signature of Ow r/Lessee/Contractor as Agent for Owner Signatur of Con r ctor/License Holder
STATE OF FLORIDA STATE Of FLORIDA
COUNTYOF ����1�. COUNTY'OFmw��
The forgoing Instrypent
(�as acknowledgepefore me The forgoing instrument was acknowledg pefore me
this�rnday of F 20" by this ISH day of APRIL —20J by
PHILIP NISA JR
Name of pers n making statement Name of person making statement
Personally Known OR Produced Identification Personally Known xx OR Produced Identification
Type of Identificatiot Type of Identification
Produced Produced
,n
Signature of Notary Public Stat of, a re of Notary Public-
- KRISTIN l3AIT$ pLTg ;►r KRISTIN IIBAITSHOL 5
Commission No. d 1`T JYGOMMIS3►QN# Ftg ion No. FF2074� =p :� MY�011$3fON#FF201.
EXPIRES F - __ .
abrubry $ZQ3& ' o EXPM5 FjbpAry l%"
poi ageo�saw.r�ro;
'. i407�J98-015.1 i1aWrNotsry4H'+wo00a .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 - ---- - -