HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: jk } 3- IS Permit Number:
1 _
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
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION;
Commercial t,-� Residential
Address: H1 (Do- I---). H� A kA -4
Legal Description:
Property Tax ID #: IL_(� "SC} :M- H Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
t I
for
► A/C
C)CA-C r-
-tom, I y s ,� ��} o I--1 ) 0 f -w r
Address:G1 (1- . 1 I A
Company: Cool Air Solutions of Florida, Inc.
City: F -a--+ _�) iefCCState: _E—L
Zip Code: �I 1's Fax:
Phone No.-- [O- pS Lp- ) 9 S_�
CONSTRUCTION
INFORMATION:
E -Mail:
Additional work
R]HVAC
to be erformed
Gas Tank
under this permit- check
Gas Piping
a appy:
Shutters Windows/Doors
_
Electric
Plumbing
Sprinklers
LSI
Generator
El
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1-I , 1--I 00. c)
ScFt. of First Floor: _
utilities: Sewer D Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name_ cl--- C1C,_ b_'- YAF(_
Name: Shyanwoitczak
Address:G1 (1- . 1 I A
Company: Cool Air Solutions of Florida, Inc.
City: F -a--+ _�) iefCCState: _E—L
Zip Code: �I 1's Fax:
Phone No.-- [O- pS Lp- ) 9 S_�
Address: 6903 Cabana Lane
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-801-5398
Phone No. 772-634-0491
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: coolairsol@gmail.com
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:
MORTGAGE COMPANY: Not Applicable
N a m e: Shyan WoltUA
Address:
Address:
City: State:
Zip: Phone
City: Fort Pierce State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address: 6903 cabana Lane
BONDING COMPANY: Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFI DVIT: 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.
Signature Owner/ Less tractor as Agent for Owner Signature -if Contractor a Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF '�— i 0(—, dL�_ COUNTY OF �kLor r -e
The forgoing instrument was acknowledge before me
this ]�R-day of.:A a_A �,Pm = 20LL by
IL
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced — Cr
(Signature of Notary Public- State of Florida )
Commission No. i c ( Stephanie I
e NOTARY F
i '+STATE OF
REVIEWS FRONT I ZONING SUPMI'S
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The f/orgging instrument was acknowledged before me
this day of ✓I)Dyf','1)1a�.� 20 by
Name of person making statement
Personally Known OR Produced ldentificatior
Type of identification
Produced r—l_ Ot -
(Signata(re of Notary Public- State of Florida )
Stephanie I
~ommission No. NOTARYP
G STATE OF
RIDA ? Comm# FFA
_PTANS I VEGETATION SEA TURTLE I MANGROVE
REVIEW I REVIEW I REVIEW REVIEW