HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06/24/2019 Permit Number:
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT TYPE: MECHANICAL
PROPOSED IMPROVEMENT LOCATION:
Address: 6762 DICKINSON TERRACE
Property Tax ID #: 3415-706-0050-000-5
Site Plan Name:
Project Name: MARIAN KLEMAN
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK: I
HVAC LIKE FOR LIKE 4 TON 16 SEER 10 KW
FCONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank — Gas Piping — Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 6995.00
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MARIAN KLEMAN
Name: FREDERICK MILLER
Address: 6762 DICKINSON TERRACE
Company: MILLERS CENTRAL AIR, INC
City: PORT ST LUCIE State: iL
Address: 20 W INTERLAKE BLVD
Zip Code: 34952 Fax:_
City: LAKE PLACID State: FL
Phone No. 814-341-8665
Zip Code: 33852 Fax: 772-344-6480
E-Mail:
Phone No 772-785-8080
Fill in fee simple Title Holder on next page ( if different
E-Mail OFFICE a@MILLERSCENTRALAIR.COM
from the Owner listed above)
State or County License CAC058675
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Add ress:
Add ress:
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 commented prior to the issuance of a permit.
5t. Lurie 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 accessary 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 of Owner Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
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ev. 2/7/19