HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 111 9/201 8 Permit Number:
s' 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) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 1295 BENNETT RD
Legal Description:
Property Tax ID #: 231312400010005
Site Plan Name:
Project Name:
Setbacks Front Back: _
DETAILED DESCRIPTION OF WORK:
Replace existing 5 ton system with new
Goodman 5 ton 16.5 seer wl5kw heat
Models GSXC16060 & AVPTC61 D
Right Side: Left Side:
Lot No._
Block No.
CONSTRUCTION INFORMATION:
CONTRACTOR:
NameAnthony Conant
Name:
rme un er t is permit —c ec
Additional work to fl F]Gas Piping
app y:
El Shutters
F]Windows/Doors
HVAC
City: Port St Lucie State: FI
Zip Code: 34953 Fax: 772-336-4171
Phone No. 772-336-2448
Gas Tank
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E -Mail: tdsac@aol.com
State or County License: CAC035553
Electric Q Plumbing
Sprinklers
El Generator
F]Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $ 4800.00
Litilities:qn
Sewer E]
Septic
Building Height:.
OWNER/LESSEE:
CONTRACTOR:
NameAnthony Conant
Name:
Address: 1295 Bennett Rd
Company: Tracy D Steele Air Conditioning Inc
City: Ft Pierce State: FI
Zip Code: 34947 Fax:
Phone No.772-260-4959
Address: 2750 SW Edgarce St
City: Port St Lucie State: FI
Zip Code: 34953 Fax: 772-336-4171
Phone No. 772-336-2448
E -Mail:
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E -Mail: tdsac@aol.com
State or County License: CAC035553
If value of construction is 52500 or more, a RECORDED Notice of Commencement is requires.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: Stater
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: 2750 SW Edgarce 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. 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.
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t
Signature of Owne / Less ontractor as Agent for Owner
Signature of Contfacl&ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST LUCIE
COUNTY OFST LUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
NOVEMBER
this 19 day of NOVEMBER ZQ ff by
this 19 day of 20� by
N me of person making statement
Nam of person making statement
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature ofo ary Public- State of Florida 1
CommissionCommissio
OV Jyt Notary Public State of"Fir4%
OT Notary *ubliC State of Flositla
Daniel F Stacey
Daniel F Stacey
+ My Commiraion GG 251653
LROVE
1653
a Expire 08/2212022
a a
REVIEWS RVISOR
PLANS
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17