HomeMy WebLinkAboutPermit Application for 5401 W Echo Pines Circle ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -c��- O Permit Number:
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Building Permit Application
Planning and Development5ervices
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:1�5l-I d 11 C—&�0 T. c►c Cl e
Legal Description:
Property Tax ID#: - Q - C-)0C-) Q Lot No.
Site Plan Name: Block No_
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit-check all apply:
®HVAC Gas Tank OGas Piping _Shutters Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �Acn, ��� Utilitiest Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name i C r Name: Shyan Wojtczak
Address: b QGho + C lr Company: Coal Air Solutions of Florida, Inc.
CityJ7Q(--A- (-CE State:EL Address: 6903 Cabana Lane
Zip Code: , ICI Fax: City: Fort Pierce State:FL
Phone No. ��l - LA 4S- Zip Code: 34951 Fax: 772-801-5398
E-Mail: Phone No. 772-6340491
Fill in fee simple Title Holder on next page j 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 LAIN 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.
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Signature o wner/Lesse-el"rador as Agent for Owner Signature orf Contractor/Lice Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF , L✓ ,-P ___ COUNTY OF
The forgo'mg instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisc)l day of 204 by this--Y9Tday of 20 by
ame of person making statement rifirne of person ma ing statement
Personally Known OR Produced Identification X_ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced FL_ _l�L- Produced
{Signature f Notary Public-State of Florida } (Signature o Notary Public-State of Florida]
�~ Stephan Moure Stephanie
Commission No. �1 �� (Seal Y NOTA edi lion No. FF cl J NOTARYP B C
-.STATE FFLORIDA STATE OF L RIDA
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4 E ti W Expires Z1411u4v 19"t Expires 21 42JZU
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17