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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: i Permit Number: I- _ Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34952 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial .r Residential PERMIT APPLICATION FOR: Mechanical PROPOSED IMPROVEMENT LOCATION.' Address: - LL __W_ Li Legal Description: Property Tax ID #: } Lt. 5DS- I - 020 - i Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: �v S©ul-C- CONSTRUCTION INFORMATION: Additional work to b rformed under this permit- check a appy: HVAC Gas Tank ❑Gas Piping 1:1Shutters E]Windows/Doors Electric Plumbing Sprinklers E Generator 0 Roof Roof pitch Total Sq. Ft of Construction: Cost of Construction: $ &L 000. 0C-) Sq. Ft. of First Floor: _ Utilities: Sewer ®Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name -BUSS Name: Shyan Wojtczak Address:_Q LDUi Iii e- LUL 7+ Company: Cool Air Solutions of Florida, Inc. City: U q TT 1' co- P0I 1�1 State: E(-- Zip Coder Fax: Phone No. rQ� - i�1- q Address: 6903 Cabana Lane City: Fort Pierce State, FL Zip Code: 34951 Fax: 772-841-5398 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@gmaii.com State or County License: CAC# 1819009 it value of construction is �zsoo or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: T 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 aobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording vour Notice of Commencement. Rev. 8/2/17 - Signature Owner/ LesseJeCoAtractor as Agent for Owner Signature Contractor/Lic Ider STATE OF FLORIDA LU e STATE OF FLORID OF COUNTY OF , i COUNTY The forgoing instru nt was acknowledged before me The fgr,g pg instrument was acknowledged before me } this jb5 clay of r' Com, 20 by this day of U 20 by "Gr1 l poi - Cf�-C- C tL- ame of person making statement Aame of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification >� Type of Identification i�1 Type of identification Produced c 0 ti_._ Produced�L— _ 4(Siature t Notary Public- State of Florida } ig ature Y Notary Public- State of Florida �+ Ste Moure y Stephanie M l 3� ' (Sea Y No NOTARY P Commission No. NOTAR I�lggillKxl�ssion .,� ESTATE F FLORIDA STATE OF Comm# F967384 Comm# FF9 F957381 E 19 Expires 2/4 xplres REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17