HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE I FO ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:HVAC Equipment ChangeOut
PROPOSED IMPROVEMENT LOCATION:
Address: L > C/Z�
Property Tax ID
Site Plan Name:
Project Name:
Like for like AC replacement
Lot No. J
Block No.
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CONSTRUCTION INFORMATION';
Additiz
I work to be performed under this permit— check all that apply:
chanical _ 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: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address: 12T,5�7 %�2 �i ��'
Name: Steve Smith
Company: Steve Smith Air Conditioning
City: State:;
Zip Code: Fax:
Phone No.
Address:8001 Eden Road
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-461-2036
Phone No772-461-1425
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail stevesmithac@aol.com
State or County License CAC1 813454
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.
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DESIGN ER/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 PE JOBSM BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOURILENDWillh AN ATTORNEY BEFORE RECORDING YOUR NOTICEW COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDAI
COUNTY OF S—s L.LU F
COUNTY OF .S �'LVr e
The forgoing instrument was acknowledged before me
The forgging instrument was acknowledged before me
this Lyday of _ILIA �u 204 by
this � day of %>'161.-L 20_Ll? by
�M
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification k'
Type of Identification
Produced D(21 VEIL L I c- &.j S E
Type of Identification
Produced f u t—
ignat a of ota Public- S to of Florid ChristopherJ.
'r)MLFnature If Notary Public- State of Flo ' Stephanie Moure
p NOTARY PU
Commission No. STATE OF F.QBfPRqission
3LIC ¢, NOTARY PUBLII
No. 5F9, -l-& l a STATE OF FLOF
Comm# GG
2758 Comm# FF9573f
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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