HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
.;.v.
IJ
Building Permit Application
Planning and Development Services
Building and Cade 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: Ci I a 7)hcfeLUac�6S 1)C
Legal Description:
Property Tax ID #: 1425-701-0010-010-6
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
Like for like 2 ton 14 seer with 5kw heat
CONSTRUCTION INFORMATION:
Additional work toe rtormed under this permit -checka
apply:
HVAC Gas Tank ❑Gas Piping
Shutters Windows/Doors
OElectric EJ Plumbing Sprinklers
Generator Roof Roof pitch
Total Sq. Ft of Construction:
SFt.j of First Floor:
Cost of Construction: $ � E���� • 00 Utilities: I-1Sewer nLJSeptic Building Height:
OWNER/LESSEE; .:
CONTRACTOR:
Name :SM6 :Jcwe-4-nY et� U)2c*X �J_
Name: Shyan Wojtczak
Address: �r] ��boUrc�e AVc
Company: CoolAir Solutions of Florida, Inc.
City; �K- LLi(L-Crj!J State. LIT
Address: 6903 Cabana Lane
Zip Code:�SLAJ C)g _ Fax:
City: Fort Pierce State: FL
Phone No. Off- y., ( {�
Zip Code: 34951 Fax: 772-801-5398
E-Mail:
Phone No. 772-634-0491
Fill in fee simple Title Holder on next page ( if different
E-Mail: coolairsol@gmaii.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
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: T Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address;
City:
Address:
City:
Zi p: 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 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 your Notice of Commencement.
Rev. 8/2/17
Signatur of Owner/ LT s e/Contractor as Agent for Owner
Signature -6f Contractor cense Holder
STATE OF FLORIDA / JL�'�
COUNTY OF L�L
STATE OF FLORIDA
COUNTY OF
nstrument was ackn wiedged before me
ThZof
th20ffby
The fo . ing instrument as acknowledged Oefore me
thisayday of ��20�Yby
�!� 17Y 1)ame
of perso making statement
Name of person making statement
Personally Known OR Produced Identification i
Personally Known OR Produced Identification
Type of Identification
Produced Or ult� IG S
Type of Identification
Produced 4': l>f
iit5djr 6113x&
yBLIC
(Signa ure of Notary t
F FLORIDA
(Signature of Nota Public- StatM
NOTARY PUBLIC
e'
.
Commission No. t�� X97947
L� J r�$ ATE OF FLORIDA
Commission Nn. ' J�GGi97907
iExpares 3/19/2022
Expires 3/1912021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17