HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-26-2018
Permit Number:
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 6002 PALM DR
Legal Description: INDIAN RIVER ESTATES -UNIT 08- BLK 68 LOT 7 (MAP 34/11S) (OR 3407-272)
Property Tax I D #: 3402-609-0577-000-7
Site Plan Name:
Project Name: AC CHANGE OUT
Setbacks Front Back: Right Side: Left Side:
Lot No. 7
Block No. 68
IDETAILED DESCRIPTION OF WORK: I
Remove old AC system and install a new air conditioning system 2.5 tons 14 SEER with 5 kW electric
heater for residential property.
CONSTRUCTION INFORMATION:
Additional work to b
jrtormed under this permit — check all that appy:
Z✓ HVAC I I Gas Tank F]Gas Piping Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing ❑ Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 1189
Cost of Construction: $ J
Sq. Ft. of First Floor:
Utilities: []Sewer 11 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Grey Grouper LLC
Name: FREDDY GUILLEMI
Address: 6002 PALM DR
Company: INDOOR AIR CARE, INC.
Address: 1934 SW BILTMORE STREET
City: FORT PIERCE State: FL
Zip Code: 34982 Fax:
Phone No. 772-260-9519
City: PORT SAINT LUCIE State: FL
Zip Code: 34984 Fax:
Phone No. 772-985-3178
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: indooraircare@att.net
State or County License: CAC1816063
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:_
Address:
City:
State: _
City: State:
Zip: Phone_ _
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY:
_XNot Applicable
Name:_ _
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 I der or an at orney before
commencing w@rk or recoAiryg your Notice of Commencement. r� / I
Signature a ner/
STATE OF FLORIDA
COUNTY OF SAINT LUCIE
ntjactor as Agent for Owner
The forgoing instrument was acknowledged before me
this 26— day of DECEMBER 20__ by
LIZETTE SOLOMON
. Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
Produced
(Signature f Notary Public- State of Florida )
I
Commission No. GG211369� LIPOLOMON
MY COMMISSION #GG211369
a EXPIRES: APR 25, 2022
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
I COMPLETED
Rev. 8/2/17
Signature of Cory'Frc or/License
STATE OF FLORIDA
COUNTY OF SAINT LUCRE
The forgoing instrument was acknowledged before me
this 26 day of DECEMBER , 20_ by
LIZETTE SOLOMON
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced A
(Signature of Notary Public -State of Florida )
Commission No. GG211369
SUPERVISOR PLANS I VEGETATION I SEA71 RT
REVIEW I REVIEW REVIEW REVIEW
Sea I )LIZETrE SOLOMON
MY COMMISSION #GG211:
EXPIRES: APR 25, 2022
REVIEW