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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