HomeMy WebLinkAboutPermit Application for 5500 Palm DrAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
11111,1110 110
COUNTY
€ 1 n R 1 r.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1.578
PERMIT TYPE* Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 5500 Palm Dr.
Property Tax ID #: 3402-609-0146-000-7
Site Plan Name:
Project Name:
Permit Number:
Building Permit Application
Commercial Residential x
DETAILED DESCRIPTION OF WORK:
Like for like AC Changeout 3 ton 16 seer with 10kw heat
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: S 3000.00
Sq. Ft. of First Floor:
Utilities: Sewer `Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Charles Ansel
Name:Shyan Wojtczak
Address: 5500 Palm Dr
Company: Cool Air Solutions.of Florida, Inc.
City: Fort Pierce Sfate:Address:
Zip Code: 34982 Fax
Phone N0.772-579-8844
6903 Cabana Ln
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-Mailcoolairsol@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 HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
C #?�Pf.��IENTAL Ci'��lS i�l7CT`1C1N N IN�f31�� �T i�f
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE BOLDER: _ 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.
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{Hermit 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."
Signature of -Owner/ Lessee/to for as Agent for Owner
1�
Signature ontractor/Lic n Ider
STATE OF FLOE-4G1A_
STATE OF FLO
COUNTY OFA=-- ,a (
COUNTY OF J"[,4
The f ng instr ent wad knowledge efore me
this�day of tJ' 2Qby
The fo ung instr ent w s acknowledg before me
this day of 1 2Q, by
*
Zal _
Name of pferson making stat-afnent.
Name of p son making st ent.
Personally Knowrl___-----,OR Produced Identification
Personally Known k -----OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No
Notary Public State of Florida
Commission No. Amanda P S� n
Cprnmission G 271256
F ices w2512022
(SignatureFr fic- tratee ��,{fF
Notary FuLIrG 5r�da
Amanda P Sanderson
Commissio ommiss�onGG21My
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.