HomeMy WebLinkAboutSLC DEJOHNAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Lai, j_l Permit Number:
w
k 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
PERMITTYPE: HVAC 'CHANGE -OUT
PROPOSED IMPROVEMENT LOCATION:
Address: 8928 SAND SHOT CT
Property Tax ID #: 332750202580007
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
4 F 9 6
CONSTRUCTION INFORMATION:
Lot No._
Block No.
Ad7rMvechanical
nal work to be performed under this permit — check all that apply:
_ Gas Tank _ Gas Piping Shutters Windows/Doors
Electric _ Plumbing — Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 3500.00
Sq. Ft. of First Floor:.
Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MATTHEW DEJOHN
Name:
Address:8928 SANDSHOT CT
Company: TRACY D STEELE AIR CONDITIONING INC
Address: 2750 SW EDGARCE ST
City: PORT ST LUCIE State: C
Zip Code: 34986 Fax:
Phone No. 315 398 9024
City: PORT ST LUCIE State: FL
Zip Code: 34953 Fax:
Phone No772-215-1974
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailtdsac@aol.com
State or County License CAC035553
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C®NSTRUCTIQN k.IEN LAW IN�aRMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
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:
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 roams 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owne : Le see ontractor as Agent for Owner
AA P7�L�
Signature of Contr ctor ice se Holder
STATE OF FLORIDA
' STATE OF FLORIDA
COUNTY OF STLUCIE
COUNTY OF STLUCIE
The forgoing instrument was acknowledged before me
this -,L day of J�lq � 20 by
The forgoing instrument was acknowledged before me
this day of A} Z 20Jr by
TRACY D STEELE
TRACY D STEELE
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
roduced
Notary Public State of Ronde
Daniel F Stacey
.� .^ My Commisaion GG 251853
4} Expires 08/2212022
+ 0 Notary Public State of Florida
Daniel F Stacey
My Gornmission GG 251653
Expires 09122/2022
(Signature of Notary Publi
Signature of Notary
Commission No. (Seal)
Commission No. (Seal)
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