HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/26/18 Permit Number:
Luis g
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 x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5101 Turnpike Feeder Road
Legal Description:
Property Tax ID #: 1301-615-0019-000-1
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Like for like AC Changeout 5 ton 14 seer package unit no heat
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be Dertormed under t is permit - check all apply:
HVAC Gas Tank OGas Piping _ Shutters Windows/Doors
11Electric OPlumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction Sq. Ft. of First Floor:
Cost of Con3,200struction: $ Utilities: 0_ Sewer Os
epticBuilding Height.
a
OWNER/LESSEE:
CONTRACTOR:
Name & S Investments of St Utie'Iri
Name: Shyan Wojtczak E
Address: 3105 Ashford Sq
Company: Cool Air Solutions of Florida, Inc.
City: Vero Beach State:FL
Zip Code: 32966 Fax:
Phone No.
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
IT vaiue OT construction is �,LSUU or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: ,Not Applicable
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
commencine work or recording vour Notice of Commencement.
Rev. 8/2/17
Signature o ontractor/L Holder
Signature of caner/ Lessee/ o t for as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA ,
COUNTYOF Ci
COUNTYOF_ 1 clCn1�
The argging instrument was acknowledged before me
The forgoing instrument wa acknowledged before me
this day of r ii7�{' (�v� 20
this day of U0\Je n6(� _ , 20 l� by
lt_4�°fr1 Luc)i 1—{
`p,
Name of person making statement /
Na me of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
�l t r U r n
Type of Identification
Prod ucedsa,50 rk vLe
Produced ".r,, C
DANIELLE L HAR3o,;
r° . ''.
a� Notary Public -State o
Notary
DANIELLE I HARRIS
Zai Notary Pub iic - State of F Im id:-
d . ,
;a. o i
ig• oaf N�y�15 °rida)
�5e
(signature of Not a .St�,Ft�id�s�P to,cal"MyYNO
C (Seal)
Commission No.fc, C` (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17