HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 08/15/2019 Permit Number:
s 11
s
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578
PERMIT TYPE: hvac Change -Out
PROPOSED IMPROVEMENT LOCATION:
Address: 9117 One Putt PI
Property Tax ID #: 333450101190000
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace existing 4 ton system with;
Building Permit Application
Goodman 4 ton 2 stage 16.0 seer w/10kw heat
Models GSXC16048 & AVPTC49C
CONSTRUCTION INFORMATION:
Commercial Residential x
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
v, Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors
Electric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 4950.00
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Susumu Kurata
Name: Tracy Steele
Address: Apt 512 3-9-10 Takaido Higashi
Company: Tracy D Steele Air Cond. Inc.
City: Suginamiku Toyko State:
Zip Code: 168-0072 Fax:
Phone No.561-436-5027
Address: 2750 SW Edgarce St
City: Port St Lucie State: Fl
Zip Code: 34953 Fax:
Phone No772-215-1974
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail tdsac@aol.com
State or County License CAC035553
IT value of construction is �Z500 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:
3
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
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 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 O COMMENCEMENT."
l
Signature of Owner/ Les e/C ntr ctor as Agent for Owner
Signature of Co tra or/ icense older
STATE OF FLORIDP_
COUNTY OF. Ll_. , ft _
STATE OF FLORIDA
COUNTY OF 151
The forgoing instr meet was acknowledged before me
this j� day of 20 by
The forgoing instru ent was acknowledged before me
this _ day of 20)" by
t %ft
7
Name of person making statement.
Name of persown4aking statement.
Personally Known ___. IeOR Produced Identification
Personally Known Z OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida j
Commission
�� Notary Public State of Florida
Daniel F Stacey
Comm! I)
.� Notary Public State of i:londa
Daniel F Slacs
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DATE
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DATE
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