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1012612018 10:56 TAX) P.0021004
ALL APPLICABLE IN170 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d a� Permit Number: \1% y G (� I
FsT 'VED
Building Permit ApplicationT 2 6 2018
1 .
Planning and DevelopmentServices p 9
Sullding and Code Regulation Division County, ermittin
2300 Vlrglnla Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential XX
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 5151 N AIA #111
Legal Description:
Property Tax ID#: 1411-705-0001-000-6 _ Lot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AC change out FtUUD 16seer 2ton system 5kw
CONSTRUCTION INFORMATION;
rona wor o e e orme un err)Gas
perMi —c ec a appy:
1zHVAC El Gas Tank Piping _Shutters ❑Windows/Doors
11 Electric F:Plumbing Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 4748 Utliltles:ll Sewer 1:1 Septic Building Height:
OWNERAESS18E: CONTRACTOR:
Name William Kirchhoff Name: Scott Camira
Address:4949 N AIA#182 Company: AC Advantage Inc
City: Ft Pierce State:171 Address: 1926 SW Biltmore St
Zip Code: 34948 Fax: City: PSLucle State:F1
Phone No. Zip Code: 34984 Fax: 7723367586
E-Mail: Phone No. 7723367366
FIII in fee simple Title Holder on next page(if different E-Mail: csr@acadvantageinc.com
from the Owner listed above) State or County License:
If value of construction is$2500 or more,2 R11CORD913 Notice of Commencement is required.
1012612018 10:56 (PAR) P.0031004
SUPPLEMENTAL CONSTRUCTION. LIEN LAW INFORMATION:
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name; Name'
Address: 'Address:
City: Stater City: State;
Zip: Phone Zip: Phone:
FEESIMPLE TiTLE HOLDER: ._._Not Applicable, BONDING COMPANY: Not Applicable
Name: --- - -. ..... Name:
Address:1920 SW Biltmore St Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucle Countty�makes no representation that is granting a permit will aut orize the permit holder to build the subject structure
which;sin conflict with any$pplicable Home Owners Association rules,by aws 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 pians,the Florida Building Codes.and St.Lucle 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
comm,encing work or recording your Notice of Commencemen . C
gnature of Owner/Lessee/Contractor as Agent for Owner Sleature of-Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COU NTY OF st Lodi COUNTY OF$1 Ludt
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 26 day of Oct ZOL? by this 26 day of oot 26 by
Scoll Carnlrn Scott Cadre
Name of person making statement Name of person making statement
Personally Known xx OR Produced ldentlflcation Personally Known xx OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(S€gna ure of Notary Public-State of Florida) ( €gnatur of Notary Publi -State of Florida)
Commission No. FF1722$2 (Seal) Commission No. FF972M (Seal)
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17