HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10-3-19 Permit Number:
.. j,
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) 462-1.578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION
Address: Ll l p Q_ B 1gku_-c q A-18 U(4t
Legal Description:
Property Tax ID #: I L4 14�)— 50(D- Q()9 ,;L— WQ ~ U Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF 'WORK:
C_ U--,oau-i Y -e 3.5 lor-N ) (I Ste: r--
tufAy--N lb 1_tu +
Block No.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit- check all appy:
ZHVAC 0 Gas Tank ElGas Piping _ Shutters Q Windows/Doors
11 Electric El Plumbing []Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ]So, op
Sq. Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namef�jC+-CcCi 4 60CbG(C, TC_JU,S)LC�
Name: Shyan Wojtczak
Address: 14 -19 1cr",n i c:>t CA
Company: Cool Air Solutions of Florida, Inc.
City:, -p ii} C !'"l State: -P-A
Zip Code: 1SAL6 Fax:
Phone No. Lia 3&Jp&
E -Mail: f_QfeCJ ()S ILa C Q Yom' , I. C.DCYN
Address: 6903 Cabana Lane
City: Fort Fierce State: FL
Zip Code: 34951 Fax_ 772-801-5398
Phone No. 772-6340491
Fill in fee simple Title Bolder on next page ( if different
from the Owner listed above)
E -Mail: coolairsol@gmail.com
State or County License: 'CAG# 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 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 your Notice of Commencement.
Rev. 8/2/17
'
Signature -df Owner/Les ntractcr as Agent for Owner
Signatu f Contra ctor/6rbfts,6 Holder
STATE OF FLORIDA(S�
STATE OF FLORIDA
COUNTY OF �C rte—
COUNTY OF
The forgoJng instrument wa acknowledge_ d -before me
"�ay �_(
The forgoing instru en w s acknowledg efore me
3
this 3 of 20 by
this day of U 20LL by
: hk Icy) 1k 0ct-c
c , ®- - a I
ame of person making statement
ame of person making statement �/
Personally Known OR Produced Identification
Personally Known OR Produced Identification /�
Type of Identifitipn `�
Type of Identif' ation
�i-
Produced
Produced
(Signat a of Notary Public r c Stat iclan iel Kfaun
o� N TARY PUBLIC
Commission N o OF FLORIDA
(Signatu of Notary Public- S ate of Florida}
qs Erich Daniel Krach
Commission Na. Q s 9TARY PUBLIC
i TATE OF FLORIDA
i Comm# GG1 (75925
y Comm# GG1ff5925
El Expires 5/1712021
s Q
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE .
COMPLETED
Rev. 8/2/17