HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��/S//�S Permit Number:
� - ,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1S53 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: River Park Unit 2 BLK19 LOT 46 (MAP34/22S) (OR 3591-556)
Property Tax ID#: 3419-510-0277-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Like for Like change out
4 TON 16 SEER 10 KW
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit—check all apply:
In
FV(IHVAC Gas Tank Gas Piping _Shutters Windows/Doors
11 Electric ElPlumbing ❑Sprinklers Ei Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 6800.00 Utilities: Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Tr�Dy L (�tJ�L_S/`� _ Name: ": , r k l
Address �a i O UL ✓P�cJL Company: Millers Central Air
City: State:Fl Address: 20 West Interlake Blvd
Zip Code: 34952 Fax: City: LA /0/14,c,IC/ State: Fl
Phone No.561-512-9330 Zip Code: 33852 Fax:
E-Mail: Phone No. 772-785-8080
Fill in fee simple Title Holder on next page ( if different E-Mail: office@ millerscentralair.com
from the Owner listed above) State or County License: CAC058675
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. J
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:20 West Interlake Blvd 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.
vi
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Signature of O ner/ Lessee/Contractor as Agent for Owner Signature of C ntractor icense Holder
STATE OF FL RIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of , 20 by this day of , 20 by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17