HomeMy WebLinkAboutPermit Application for 6906 Sebastian RdALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '�^ a- l_ 1 1� Permit Number:
sI J .0@II is
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
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: 1 ,_>0 L LES- 0 J l o - CCo ^ S- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
ti -ft)c I Ike 3 +Ui- KaC1P ur-)14 (>nab 'I 4 hon -'e
Lu 10 1 L-1 5v�r
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit -check a appy:
HVAC Ei Gas Tank E]Gas Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers E] Generator 0] Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 3, ' 00
SFt. of First Floor: _
Lltilities:Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameV I ,ri
Name: Shyan Wojtczak
C
Address: b 9 0 6 SebQS i' i Qrl 1'
Company: Cool Air Solutions of Florida, Inc.
City: Edr _Ps e CCCt State: FL
Zip Code: 3y9 S 1 Fax:
Phone No. 1 - �_l 9 - 4 15� 9
Address: 6903 Cabana Lane
City: Fort Pierce State: FL
Zip Code: 84951 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# 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 thepermit 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 resutt 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 our Notice of Commencement.
Rev. 8/2/17
Signature o caner/ Lesse-O"rador as Agent for Owner
Signature of Contractor/Lice` der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF a , L_�_C , -P
COUNTY OF C } ' U\') C_ I -C_
The for�ing instrument was acknowledged before me
thisc�-'l day of 264 by
The forVing instrument was acknowledged before me
thisOi day of �Oti S 20 by
^
ame of person aking statement
fume of person ma ing statement
Personally Known OR Produced Identification ,._
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced FL_
Produced L
{Signature f Notary Public- State of Florida
lsi6nature of Notary Public- State of Florida )
Stephen', a Moure f�
Commission No. CF 9r7 J (Seal r s iE1hUdOssion No. FF'IS Ste to
NO AR
NOTARY P
-+STATi F FLORIDA -. STATE OF
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FF957381 Comm# FF
/NcE 19 Expir
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'%v4'?r1W Expires 21
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17