HomeMy WebLinkAboutWanless AC Changeout FormALL APPLICABLLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IlIff 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 V�
PERMIT APPLICATION FOR: To Select from dropbox. click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: `t9VIO 5yr,,�4 O6e'20 6r -
Legal
rLegal Description: irSl�i�re► Cl u_ �'� m/Y!
Property Tax ID 4: ��� Sl -_(?C Z r o Uv - 6 Lot No.
Site Plan Name:
Project Name: W00 (05 4G
Setbacks Front Back
Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK:
`�vm.Ovi, aid Q,�p(ace Z4n rvA fer Source._ 41e/ 7.36,9 7//
CONSTRUCTION INFORMATION:
Ad�tionaa�vork tore per7orme6- under tfiis permit = cYecl< aIi that app y
HVAC Gas Tank ❑Gas Piping ❑_ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing Sprinklers FIGenerator ❑ Roof Roof pitch
Total Sq. Ft of Construction: 5:2-
Cost
2Cost of Construction: $ w5-0 __
So. Ft. of First Floor: _
Utilities: ❑ Sewer 7 Septic
OWNER/LESSEE:
NameL�7eSS --
Address: /-;'/&0 SLr u.5 0- Wl 5-- _
City: olctG(,^,o��ee State: jL
Zip Code: _3LI-q 7y Fax:
Phone No. 9'6 3 Gay Z-7? 7
E -Mail: A/►¢
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Building Height:
Company:�a`�L p lc
Address: 1,2e &L 77 2 f
City: /_1111/_d_ ��Gc�u_e — State: 11�2_
Zip Code 3�1� �S Fax:
Phone No.
E -Mail: v,S4"" sj-,
State or County License: c'46 /z/7 Els a�
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAVs/ INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name: j
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
_1
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
city:
City:
Zip: 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 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
commencing work or recording your Notice of Commencement.
SigrAfure of Owner/Lessee/Contractor as Agent for Owner f Signa e of Contractor/License Holder
STATE OF FLORIDA k STATE OF FLORIDAOZ
COUNTY OF (�.�.r 4 COUNTY OF ,-%J �,
The for oinI Inst ent as acknowledged before me i The forgoing ins ?��r
edged before me
this day of 20/Z by this day of 20 /O by
n . A —J,/,) - �- n A
( ie o person acknowledging )
isi ature of otary P "IrStateof Florida )
Personally K own OR Produced Identification l�
Type of Idents ' ion Produced
Commission No. ;^°�; ULTER
Notary u i -State of Florida
! Commission. GG 142441
Revised 07/15/20
of person acknowledging )
(Signature Nc
Personally Kno
Type of Iden i is
Commission No.
ic- State of Florida )
OR
ion _i,-"'
(5 J. COULTER
Notary Public- State of Florida
Commission: GG 142441
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
�
INITIALS
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