HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
.PROPOSED IMPROVEMENT LOCATION: -
Address: L{ i Loo n f -IL
n
Legal Description:
Property Tax ID #: I Ll 9 3 - 50(p" () '
F Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
iI KC- -�o l- 1 K -C' I LA 5Ecr 'S --�ori Luys h
CONSTRUCTION INFORMATION:
Additional work toa er orme under this permit - check
a appy:
HVAC E] Gas Tank ❑Gas Piping
_ Shutters Windows/Doors
Electric LJ Plumbing Sprinklers
Generator Roof L�.J Roof pitch
Total Sq. Ft of Construction:
5 Ft. of First Floor:
Cost of Construction: $ i_( L -Ion . Qo Utilities: 0 Sewer 0Septic Building Height:
OWNERAESSEE:
CONTRACTOR:`
Name `0PA-h -1�CVCf—yMCje _UFC
Name: Shyan Woj tczak
Address: y I fad n pr un r -y CIO) A
Company: Cool Air Solutions of Florida, Inc.
City: (�:J IFf-C-e State: PL-
Address: 6903 Cabana Lane
Zip Code: 3L4 Fax:
City: Fort Pierce State: FL
Phone No.
Zip Code: 34951 Fax: 772-801-5398
E -Mail:
Phone No. 772-6340491
Fill in fee simple Title Holder on next page ( if different
E -Mail: coolairsol@gmail.com
from the Owner listed above)
State or County License: CAC# 1819009
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
commencing work or recording your Notice of Commencement.
Rev. 8/2/17
DA
Signature of. wner/ Lessee/Cradtor as Agent for Owner
Signature of ontractor/Lice s doder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF (—UC t £'' _ _
COUNTY OF S� . L .mac P
Th f rgoing instrument was acknowledged before me
'day
The forgoing instrunt was acknowledged before me
thi of 20i� by
thir�� ayaf �I 26_L6by
1L1L1d i WcJ i` ct_CA
-Name of person making statement
ame of personf6king statement
Personally Known OR Produced Identification _X
Personally Known OR Produced Identification
Type of Identification
Type of Identificatio
ill)
Produced t !1 L—
/nk -AD
Produced FL L--
�kl' fv4A (41 J -D
(Signature o Notary Public- State of Florida)
(Si nature f Notary Public- State of Florida )
y Stephanie IV cure / Stephanie
Commission No. �� j NOTARYP ESICtmission No.r J 7 1 { r NOTARY
o -+STATE OF LORIDA Q STATE OI
�i Comm# FF9
738 Comm# FI
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
DA