HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0510712018
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2.300 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: 8546 Belfry PL, Port St Lucie, FL 34986
Lega! Description: POD 28 AT THE RESERVE LOT 36 (OR 3894-2453
Property Tax ID #: 3327-701-0039-000-7 Lot No. 36
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Change out residential air conditioning system
CONSTRUCTION INFORMATION:
Additional work to je�e orme under this permit -- check a app y:
Lr (HVAC Gas Tank Das Piping _ Shutters Windows/Doors
LJ Electric Plumbing OSprinklerr Generator Roof Roof pitch
Total Sq. Ft of Construction:.
Cost of Construction: $ 3800
S Ft. of First Floor: _
Utilities:0Sewer Septic
Building Height-
OW
eight:
OWI'NER;(LESSEE:
CONTRACTOR:
Name John Koopman —�
Name: David Kruse
Address: 16900 N Bay Road, BLD 3, APT 2504
Company: AC Doctors Inc
City: Sunny Isles Beach State: FL
Zip Code: 33160 Fax:
Phone No. 1-786-486-8692
E -Mail: JK_COACH@YAHOO.COM
Address: 1853 Biltmore Street
City: Port Saint Lucie State: FL
Zip Code: 34984 Fax:
phone No 772-344-3944
gmaii.com
E -Mail: acdoctorsinc@gmaii.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CAC058461
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Y-,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: John Koopman
Name: David Kruse
Addres5:9546Belfry PL, Port Sl Lucie, FL 34988
Address: 16900NSo,Road.SLID 3,APT 2504
City: Sunny Isles Beach State:
City: Pod Saint Lucie State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY' _Not Applicable
Name:
Name:
Address: 1853 Biltmore Street
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 CountyY makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 hereb+ 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 �I
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
commencinp work or recording our Notice of Commencement.
0��
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ` /
COUNTY OF �FTiN
STATE OF FLORID
COUNTY OF 'V Ti✓
The forgoing instrument was acknowledged before me
this day of Tn 20-4 by
The forgoing instrume t was acknowledged before me
this � day of 20j!� by
/)HJQ 2t4/�e
Alit 7) &05C
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identi/f(p tiTon
)
Produced 1 /4 /JL
Type of
Produced entitisk
(Signa a of N taryP I' ate of Florid j
(Sign a of Notary Ic tate of Flo ' a
ot01Ae1li DAVID CSHEPHERD
Commission No. _ ' ' `* M(�,IWSIONMGG052274
o��:.pee4 DAVID CjjM�CCH,E,,,Pryry€€R)
Commission No. ? '' '' ° commisSrtN GG 052274
wlc� EXPIRES: Dedem6er4, 2020
�lrOFRop Banded Thn Budpel No"Sermes
ur a EXPIRES: De�ember4, 2020
�rFaFPtoBOOM Thu 9udyet Nctazy Se s
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17