HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3-21-19
F
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: Mechancial
PROPOSED IMPROVEMENT LOCATION:
Address: 2023 Saint Lucie Blvd Lot 314
Property Tax ID #: 1433-504-0243-000-5
Site Plan Name:
Project Name:
Permit Number:
Building Permit Application
Commercial Residential X
DETAILED DESCRIPTION OF WORK:
Like for Like AC Changeout 4Ton 14seer package unit with 10kw
CONSTRUCTION INFORMATION:
Lot No._
Block No.
Additional work to be performed under this permit– check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
— Electric Plumbing , Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 3,100
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Marshall Langley
Name:Shyan Wojtczak
Address: 2023 St Lucie Blvd Lot K
Company: Cool Air Solutions of Florida, Inc.
City: Fort Fierce State: _
Zip Code: 34946 Fax:
Phone No.
Address: 6903 Cabana Lane
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-801-5398
Phone No 772-634-0491
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 required.
If value of MVAC 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.
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 thepermit 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.
Gv,
Signature Jo o Owner/ Lesse c actor as Agent for Owner Signature-gif Signature-Contractor/Lice& H der
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF Ste` LCOUNTY OF
The forgoing instrument was acknowledged before me
this'Z! 5 rday of Ja(2_�t� 20119 by
SITYAN WOJTCZAK
Name of person making statement.
Personally Known OR Produced Identification _
Type of Identification
Produced�it-2
The forgoing instrument was acknowledged before me
this2,s-; dayof 4-L 20-L(� by
SITYAN WOJTCZAK
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced 7L—\ J c -A- i' ic-c jsc
aJ l
( 'g of tart' ublic- State of i a) Christopher J. Frpvff (Sig' ature f f(otar Public- State of Flora a) Christopher J. Fryaul
�'22.��iS� � NOTARY PUBLIC � OTARYPUBLIC
Commission No.�r a ESTATE OF FLORIDA Commission No.G&r�2��a � TATEOFUBLIC
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DATE
RECEIVED
DATE
COMPLETED