HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: O
RECEIVED
Building pp Permit Application I
Planning and Development Services APR 17 2018 i
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34982 ST. Lucie County, Permitting
Phone:(772)462-1553 Fax: (772)462-1578 Commercial ResidentiaTW- - -
PERMIT APPLICATION FOR: Mechanical 0
PROPOSED IMPROVEMENT LOCATION:
4
Address: UA& 1 C,iCk
Legal Description:
Property Tax ID#: 1 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 Derformed under this perms —check a 11 that apply: i
ZHVAC Gas Tank EGas Piping _Shutters E]Windows/Doors
11 Electric 0 Plumbing Sprinklers [l Generator Roof Roof pitch
Total Sq, Ft of Construction: Sq. Ft, of First Floor:
Cost of Construction:$ `"1 2-'•DO Utilities: Sewer Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name I Name: i�� J
Address:�I .� �ti S1T�e. Company: NISAIR AIR CONDITIONING
City: Stater_ Address: b(: s h1
Zip Code: (� Fax: City: ffiel FirvaState:FL
Phone No.' Zip Code: 34982 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 revlew 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
improvementsto 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 4th lender or an attorney before
commenc.ing w`rkor recording our Notice of Commencement.
1
Signatur of Owne essee/Contractor as Agent for Owner Signatu a of Con ctor/License Holder
STATE FLORIDA (11 C, /i STATET OF.--
The
IDA
COUN F J 1 -t-.0 nw°°
I
The forgoing instru ent was acknowledge before me The forgo I g Instrument was acknowledged before me
this r]_day of 20 by this 17TH day of APRL 20_�hby.I � N�S a � I
PHILIP NISA JR
N me of pe2con making statement Name of person making statement
Personally Known\4/ OR Produced Identification Personally Known xx OR Produced identification
Type of Identificatidaan"'- Type of Identification
Produ ed Produced
�A'"I!Z'�
t��lL
( i nature of Notary Public-State of FI n i nature of Notary Public- i
r` KRISTIN I3 RgN�LY pr"'i KRISTIN I3i►CfSNOL
Commission No. MY CatitM�SS1 r�43 ' I�l I O. FF201485 ;. My( ��q FF20t
EXPIRES Fa a } EXPJRtE FebfuBty}.@ 20
i4071398{It S3 a,20�s i4o713Z.3 ildid+N�tnrySvnca c.Om
Fk+IdrNotary er,n:o r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17