HomeMy WebLinkAboutBuillding Permit application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 51 aFIT " 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 X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 8202 CAPER LN
Legal Description: SAVANNA CLUB-PLAT ONE-BLK 9 LOT 39 (OR 1998-2419;3230-2834)
Property Tax ID#: 3425-701-0186-000-3 Lot No.39
Site Plan Name: Block No. 9
Project Name: RONALD GASVODA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
A/C CHANGE OUT
CONSTRUCTION INFORMA now
Additional work toa orme under this permit—check a appy:
Z✓ HVAC F]Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers 12 Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 4936.96 Utilities:Sewer El Septic Building Height:
OWNERXESSEE: CONTRACTOR:
Name RONALD GASVODA Name: MICHAEL FORGIONE
Address:8202 CAPER LN Company: UNIVERSAL AIR&HEAT
City: PORT ST LUCIE State:fl Address: 5460 W STATE RD 84# 12
Zip Code: 34952 Fax: City: DAVIE State:FL
Phone No.317-590-2784 Zip Code: 33314 Fax: 954-318-0584
E-Mail: Phone No. 954-581-7110
Fill in fee simple Title Holder on next page(if different E-Mail: Permitting@Uahac.com
from the Owner listed above) State or County License: CAC058142
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: 4Not 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commeri in work or recording our Notice of Commencement.
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/, of Owner/Lessee/Contractor as Agent for Owner.00 � re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF BROWARD COUNTY OF BROWARD
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 29 day of MAv 20LT by this 29 day of MAY 20JS by
MICHAEL FORGIONE MICHAEL FORGIONE
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-St a Signature of Notary Sate o pgmw SwW
Nolory Pub)io&ata of FI 4tAP1E psi um
Commission No. GG 150387 I)31ecle Pegure 5%mi ion No. GG 150367 � e I)My pap411uelon 00 s 7
My Commission 04 1 03137 € %�roystax?
p1 EX065 02/02/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17