HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i() - 5 --1 Permit Number: �) C))Lf'5
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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 X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION: ._
Address:_:I I CJ
Legal Description: LAKEWOOD PARK-UNIT 10 BLK 130 LOT 6(MAR 13/01S)(OR 311-2541)
Property Tax ID#: 1307-612-0268-000-2 Lot No.6
Site Plan Name: Block No. 130
Project Name: KENNTH LAGASSEY
Setbacks Front Back: Right Side:_ Left Side:
DL`TAILED [?ESCRlPT1)N OF WORK:
K
A/C CHANGE OUT
3.5 TON
16 SEER
7 KW
CONSTRUCTION INFORMATION:
Add-ii iona wor to ee ormed un er t .i mit —c iec a app y: �
F✓ HVAC Gas Tank ❑Gas Piping1J Shutters a Windows/Doors
Electric Plumbing Sprinklers F_Generator Roof Roof pitch
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction:$ 4096.50 Utilities:]Sewer 0 Septic Building Height:
DWNER/LESSEE: CONTRACTOR:
Name KENNETH LAGASSEY Name: MICHAEL FORGIONE
Address:7102 KENWOOD RD Company: UNIVERSAL AIR&HEAT
City: FORT PIERCE State:FL Address: 5460 W STATE'RD 84# 12
Zip Code: 34951 Fax: City: DAVIE State:FL
Phone No.772-828-6467 Zip Code: 33314 Fax: 954--318-0584
E-Mail: Phone No. 954-581-7110
Fill in fee simple Title Holder on next page(if different E-Mail: Permitting@Uahac.com
from the Owner listed above) State or County License: CAC058142
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTFON MIEN LAW INFORMADON:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: Not Applicable
Name: I, 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.
Y
e of Owner/Lessee/Contractor as Agent for Owner gnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF eROWARo COUNTY OF eRO—RD
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 4 day of ocroeeR Zp_ by this a day of ocreseR _ _ 20___ by
MICHAEL FORGIONE MICHAEL FORGIONE
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Notary NUtrlw Matt pi Flc+ida XNotpry PubIK State of Ftor+dsc—. Slaua Paquraw C` l tave Papura
1—M.,WV9212022
My Commtas on GG 150387 ' I`Gy Gommluron GG 150367(Signature of Notary Publt (Signature of Notary Pu c- a '
Commission No. GG 15067 (Seal) Commission No. GG 15067 (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