HomeMy WebLinkAbout permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 04/24/2018 Permit Number:
i_
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 421 SE Gasparilla Ave., Port St. Lucie
Legal Description: RIVER PARK-UNIT 4 BLK 34 PART OFLOTS 15 AND 16 MPDAF
Property Tax 10 #: 3419-530-0093-000-1 Lot No. Parts of 15 & 16
Site Plan Name: Block No. 34
Project Name:
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: I
Replace alc equipment, like for like - Rheem 3.5 ton 16 SEER with 1 Okw electric heat
I CONSTRUCTION INFORMATION:
Additional work to b,e prtormed under thiS permit - cneck all tJ apply: o Windows/Doors DHVAC _ Gas Tank DGas Piping _ Shutters
D Electric D Plumbing 0 Sprinklers D Generator DRoof I I Roof pitch
Total Sq. Ft of Construction: S8 of First Floor:
Cost of Construction: $ 9700.00 Utilities: _ Sewer D Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Michael Morrison Name: Jacques Stiegelman
Address: 421 SE Gasparilla Ave Company: Jack FrostAC of South Florida, Inc.
City: Port St. Lucie State: FL Address: 1716 SW Biltmore St.
Zip Code: 34983 Fax: City: Port St. Lucie State:~
Phone No. 772-344-8638 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: jackfrostflorida@aol.com
from the Owner listed above) State or County License: CAC1815725
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: i Not Applicable MORTGAGE COMPANY: 'f.. Not Applicable
Name: Name:
Address: Address:
City: State: --- City: State: ---
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: .p_ Not Applicable BONDING COMPANY: E_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 be recorded and posted on the jobsite
before the first I spection. If you intend to obtain financing, consult with lender or an attorney before
commencin rk or recordin our Notice of Commencement.
Signature of
STATE OF FLORIDA
COUNTY OF si Lucie -----------------
STATE OF FLORIDA
COUNTY OF_S_t_Lu_ci_e _
The f.?~jilli.~g instrflfn! was acknowledged before me
this ~~ay of /)(11 ,20.J.j_ by
Jacques Stiegelman Jacques Stiegelman
Name of person making statement
Personally Known xx OR Produced Identification _
Type of Identification
Produced_r- -t- __ ---,.,e.-.-r
Name of person making statement
Personally Known xx OR Produced Identification
Type of Id ntification
Prod uce-/- ---/'-k-_---/'-f-
ure of Notary Public- State of Florida)
:\~y ~ Kristina R. Parsons
Commission No. ~ NOTAR~$.IC
•.• STATE OF FLORIDA
..._ •.•...•.• ""'.'"'" Comm# GG090836
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
MANGROVE
REVIEW
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17