HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3120/19 Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 4000 N A1A Unit # 501
Property Tax lD #: 1423-503-0007-000-5
Site Plan Name:
Project Name:
Building Permit Application
Commercial X Residential
DETAILED DESCRIPTION OF WORK:
Like for like AC changeout 5 ton 16 seer watersource heat pump
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit– check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 5,400.00
Sprinklers _ Generator
Sq. Ft. of First Floor: _
Lot No.—
Block
o._Block No.
Windows/Doors
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Donald & Susan Van Dyke
Name:Shyan Wojtczak
Address:4000 N A1A, 501
Company: Cool Air Solutions of Florida, inc.
City. Fort Pierce State:l
Zip Code: 34949 Fax:
Phone No. 561-214-3402
Address: 6903 Cabana Lane
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-801-5398
Phone No772-634-0491
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail coolairsol@gmail.com
State or County License CAC# 1819009
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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
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 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."
Signatur Owner/ Lessee C ntrapkor as Agent for Owner
Signature of ontractor/Lice s Rolder
STATE OF FLORIDArr r
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STATE OF FLORIDA SL✓�
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COUNTY OF L,Cr
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The forg`p4ng instrument was �cknowiedged before me
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The forgpAg instrument was e nowledged efore me
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this Za day of Moi 20 by
this-lZday of t 20 el by
Name ofterson making-3tatement. T
Name of erson making sta ment.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific ion �w
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(Sign ture of Notary Public- State�owp�ida )Erich Daniel Krach
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(Signa re of Notary Public- Sta e of Florida) Daniel Krac
�� O �� NOTARY PUBLIC
Commission No. ( )TATE
Erich
��Rvkssa NOTARY PUBLIC
Commission No.G� �,9 z
OF FLORIDA
o� _STATE OF FLO
Comm# GG105925
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ExPIMS
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REVIEWS
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
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