HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/5/2018 d , Y. ;" Permit Number: OLS l(
'Building Permit Application ;
j 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'
i' PERMIT' APPLICATION FOR:- -Mechanical - -
jP:ROPOSED IMPROVEMENT LOCATI N
Address: 9200 one Putt Place Club-House -
Legal Description: Island Club House
Property Tax ID#: 3334=501=0005-000/8 Lot No.,
Site Plan Name:
; Block No.
Project Name:
Setbacks Front Back: Right Side:. Left Side:
%`QESCR OF WORK: x'.xr.<
Change out like for like"replacing Lennox 2 speed, 3 ton ac unit with carrier 2 speed 3 ton AC, "
condenser 24ACB736AO03, and air> ndler-FV4CNF005L00, 16 SEER, 8 kw heat.',`
CONSTRUCTION,3IN FORMATION
Additional work toe nertormecl under this permit—check all appy:
❑✓ HVAC 0 Gas TankGas Piping _5hu#ters ❑Windows/Doors ..
DElectric Plumbing Sprinklers ❑Generator Roof F 1 Roof.pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ $5000.00' Utilities. Sewer Septic Building Height:
101IVNER%LESSEE t - � CONTRAC_T'O`R
Name'PGAMillage POA'dnc:.,' Name: KeithtThompson; '` }*
,Address.2140 Reserve Park Trace Company AC KeitH'Inc `
y. Port St Lucie _ "
Cit State:FL A... Add"gess 90=SW'Pueblo Terrace
Zip Code: '34986 Fax;n/a,, City: Port St!L-ucie State:FL.
Phone No.561-866-8110, ' Zip Code:-34953. Fax: n/a
E-Mail:dianeb@langmanagement.com Phone No. 772-519-1351
Fill in fee simple Title Holder on next page'(if different 'E-Mail: ackeith1"(giatt.net
from the Owner listed above) State or County License:-CAC1813976 -
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.:
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:690 sw Pueblo Terrace 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 y intend to obtain financing,-consult with lender or an attor ey before
commencin work or r g your Notice of cemgny.
n
Signature of Own erf Less /Contractor as Agent for Owner Signature of Contract /Lic se Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF C'�e COUNTY OF uL C.C
The fo 4oing instrument was acknowledged before me The fo going instrument was acknowledged before me
this�—day of oec-z—ht.' 20jA by this Srvday of 00-(,21n b 20 IS by
1/.e:�l�". 1ho,^pSor/1
Name of person making statement Name of person mak ng statement
Personally Known OR Produced Identificationy/ Personally Known OR Produced Identification
Type of Identi 'cation Type of Identification
Produced L i S l SO34, �0 Produced, f L10), 't m�19 S 6_10 as)o
(Si ture of Notary Public-Stat ature of Notary Public-Stat of; a) FRANCESCO MASUTTI
oi►aY � FRANCESCO MASUTT =�' NotaryPublic State of Flo •d
Commission No. �A•( aHotary Public State of FI r mission No. �� •e-SeaQ mmission#GG 26537
' CC Commission#GG 2653 1oFF°
-',!�'oF c��'•- y p• •••••••••• My Comm.Expires Nov 6, 2
M Comm.Expires Nov 6,2022
REVIEWS FRONT ZONING _SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17