HomeMy WebLinkAboutPermit Application for 6804 Lakeland Blvd ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l I � z Permit Number:
i
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 L-�
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION
9C_ 1 t
Address: Is� 1 0H — L C;i I VI
Legal Description:
Property Tax ID#: 1 �)C) t - (L' - 0 - 000- S_ Lot No.
Site Plan Name: Block No.
Project Name:.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
oc I Le- 3 . J c% S Ee(— LU i-- V-1 a �L11`a
CONSTRUCTION INFORMATION:
Additional work to je oe orme under this permit-check a apply:
®HVAC L_J Gas Tank ®Gas Piping _Shutters ®Windows/Doors
L_lElectric ❑Plumbing Sprinklers Generator 13 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ .3(.. 0P- 09 Utilities:cn Sewer Elseptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name H ctf c)(C� I r CtC 11 Name: Shyan Wojtczak
Address: (A OLI �-- K-e i C,ir-d b I yd Company: Cool Air Solutions of Florida, Inc.
City:'FO C4- __P i e{02- State: F-L. Address: 6903 Cabana Lane
Zip Code:�Jt-I 15 l Fax: City: Fort Pierce State:FL
Phone No. S 4 1 - It (_0 - a �y 0 Zip Code: 34951 Fax: 772-801-5398
E-Mail:ICZ2 CG� 3Q CAL) [C3 Phone No. 772-6340491
Fill in fee simple Title Molder 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 MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: 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 our Notice of Commencement.
Signature Owner/Less e CoAtractor as Agent for Owner Signature efContractor/Lic Ider
STATE OF FLO A STATE OF FLORID
COUNTY OF t-• Luc COUNTY OF Le
The forgoing instrunt was acknowledged before me The f rg .ng instrum nt was acknowledged before me
thi_5,;��4-day of 0 uV- — ,20J�3 by this ll day of U + 2o_r by
ame of person making statement Aame of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced F L 'DZ— Produced P L �n C_„
(Si ature Kf Notary Public-State of Florida ig ature of Notary Public State of Florida)
Vy Stephan Moure y Stephanie MCommission No_ 7 (SeaNOTAF2 } ssion No. l !`Qf f NOTARYP B C
o'ZSTATE F FLORIDA � v STATE OFL IDA
Comm# F9S7381 Comm#FF9 T 1
�Y is Expires214 xpires 12 20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
OUNAPLETED
Rev.8/2/17