HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: May 15, 2019 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPE: ,A/C Changeout
PROPOSED IMPROVEMENT LOCATION:
Address: 264 N. Coconut Ave Port St. Lucie, FL 34952
Property Tax ID #: 3 L'! of 510 0 [ (P,] oo 0 Lot No. 23
Site Plan Name: Block No. 15
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace a/c equipment like for like
New Condenser Model # - GSX16S361 SIN -1903088330
New Air Handler Model 3 - ASPT47D14 S/N - 1903313571
CONSTRUCTION INFORMATION:
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: Sq. Ft. of First Floor:
Cost of Construction: $ Value $3,600.00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Susanna Simon
Name: Jacques C. Stiegelman
Address: 624 N. Coconut Ave
Company: JackForts AC of South Florida L.L.C.
City: Port St Lucie State: PL
Zip Code: 34552 Fax:
Phone No.
Address: 1716 SW Biltmore St
City: Port St Lucie State: FL
Zip Code: 34984 Fax: 7723369032
Phone No 7723369030
E -Mail:
Fill in fee simple Title Holster on next page (if different
from the Owner listed above)
E -Mail jackfrostFlorida@aol.com
State or County License CAC 1815725
it value or construction is ,1oLSifU or more, a RLCURDED Notice of Commencement is required.
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.
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 INTEN T OBTAIN FINANCING, CONSULT
WITH YOUR L NDER O ATTORNEY BEFORE RECORDING YOUR TILE F QMMENCEMENT.-
Rev.
Signature of Owner,// seetontractor as Agent for Owner
Signature of Go tractor/License Holder
STATE OF FLO�1D�f
STATE O LORIDA
COUNTY OF St. ucae
COUNTY OF St. Lucie
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 15 day of May 20-K by
this 15 day of May 20-a by
Jacques C. Stiegelma
Jacques C. Stiegelma
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
Produced
4
6
V( e#
ignature o Not Public- St e a ry Public State o 0
(Signature of N tary Publi S e to ublic tate of Florida
y I L Gonzalez
ydia L Gonzalez
GG 225734 K M Commission GG 225734
Commission No. M1d Ei� ]D610&2022
+� r My Commission GG 2257
mmission No. GG 225734 ' .&df (_%Vl�s 1)5/06/2022
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