HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO ``MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:] i ! Permit Number:
s
41111111111
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial.- ._ _ _ _.._ , Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION: -
Address: LIGIOCt C"C :tC
Legal Description:
Property Tax ID #: i - C -00SO -- 000- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: -
t V .0 1--c. A c-'ti—N U SCC $. �.�r 1 ` �\ � C
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit- check a appy:
9HVAC Gas Tank ®Gas Piping _ Shutters O Windows/Doors
11 Electric Plumbing []Sprinklers ® Generator F� Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 3900 • 0 (�
SFt. of First Floor: _
Utilities:] Sewer OSeptic
Building Height:
OWNERAESSEE;. =
CONTRACTOR.
Name �u l l i Grp-0toe,I`l
Name: Shyan Wojtczak
Address LA 0 9 C—C W C -,D( .
Company: Cool Air Solutions of Florida, Inc.
City: {.- i of Cc Stater
Zip Code: ,JL1q � ` Fax:
Phone No.
Address: 6903 Cabana Lane
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-801-5398
Phone No. 772-6340491
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: coolairsol@gmail.com
State or County License: CAC# 1$19009
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.
Signature o wner/ Lesse_e/_okractor as Agent for Owner Signature of Contractor/Lice der
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF a , L_. _C_ '-p �COUNTYOF _< t , Lt -)C_ 4 -e-
The for ng instrument was acknowledged before me
thisc�l day of 204 by
-Name of person making statement
Personally Known OR Produced Identification XC
Type of Identification
Produced _F _b�_
(SignaturObf Notary Public- State of Florida )
Commission No. FF ��^% 38 j (Seal
REVIEWS I FRONTZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. $/2/17
The forgoing instrument was acknowledged before me
this�J4 day of U I j S t: , 20�1 by
N�me of person ma ing statement
Personally Known OR Produced Identification
Type of Identification
Produced F �_ 1l) �__
- (Signature of Notary Public- State of Florida j
Stephan MoureStephanie i
r4OTAR mesion No. EF E �i N I NOTARYP
STATS F FLORIDA Ah STATE OF
Com Fry5r3n i Comm# FF
1 E rg � E_xpir s �'WrW Expires
SUPERVISOR PIANS VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW