HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: NOVEMBER 29, 2018 Permit Number:
17s
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
Address: 7033 WILLOW PINE WAY, PORT ST LUCIE, FL 34986
Legal Description: POD 6 PUD 1 AT THE RESERVE WILLOW PINES WEST AT PGA VILLAGE (PI3 42-33) LOT 24 (OR 2044-325)
Property Tax ID #: 3322-621-0033-000-5
Site Plan Name:
Project Name: KOZLOW
Setbacks Front Back: _
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTIONOF Ii1�ORK:
INSTALLATION OF A HORIZONTAL 3 TON 16 SEER 1OKW RHEEM COMPLETE SYSTEM
CONSTRUCTION I -FORMATION,.
itionaCwork to be nertormed under this permit– checK ail apply:
HVAC Cas Tank RGas Piping — Shutters Q Windows/Doors
L l Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 4500.00 Utilities: Sewer R Septic Building Height:
OWNER/LESSE' :
CONTRAC OR:
Name ELIZABETH KOZLOW
Name: LUKE WALKER
Address: 7033 WILLOW PINE WAY
Company: TREASURE COAST AIR CONDITIONING
City: PORT ST LUCIE State: FL
Address: PO BOX 460
Zip Code: 34986 Fax:
City: JENSEN BEACH State: FL
Phone No. 305-798-5068
Zip Code: 34958 Fax:
E -Mail:
Phone No. 772-692-1701
E -Mail: TCAC1990@ATT.NET
Fill in fee simple Title Holder on next page (if different
State or County License: CAGO68476
from the Owner listed above)
If value of construction is 52500 or more, a KECORaEQ Notice oT Lommencemenz is requ+rea.
SI�PPL Nl ITA . CONSEN t:A1Af INQR11��1T��QN
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
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: PO BOX Oso
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.
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 orour Notice of Commencement.
_.recording
Signature of O er/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Lic6nse Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF —
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 29 day of _NOVEMBER 20 by
this 29 day of NOVEMBER 20_ by
LUKE WALKER
LUKE WALKER
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
(Signature of Notary Public)State of Florida)
-JSignaturk of Notary Public -/State of Florida )
Commission No tAURAA R
♦eh4/rR�/M.F�
Gommissio pyP"'•, q,READaI]
MY COMM" # GG 275744
November 12,
µY COMMISSION # GG 275744
EXPIRES: Novsm66r 12, 2022
oma: EXPIRES.
Dom;] 1nrUnUWyrMMW%1KWM
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/Z/17