HomeMy WebLinkAboutBuilding Permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: -!,2 - 19 Permit Number:
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ouiming rermn Hppucailion
Planning and Development Ser..,ices
Building oral Code Recuiation Dizision
2300 Wrginia Avenue. Fort Pierce F 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLICA 1 ION FUR: To Select from dropbox, click arrow at the end of line
PROPUSEU iMPROVEMEN I LUCA I IUN:
Address: /. 1,5 o5 POJ tM I, ti C p 2
Legal Description:
Properh, Tax ID #: 33o9 — 3 11 HOC] — a00 - q Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
I�UEfAILEU UESCRIPIION OF WORK:--
L_ //(C- & ulte J-r-A /GSr r Ckw5 e 00- 10/t A,/
CONSTRUCTION INFORMATION:
�AC�GasTank
Electric Plumbing
—cEeck_a_Tt apply:
❑Gas Piping Shutters
11 Spr nklers � Generator
1, Windows/Doors
10 Roof Rcof pitch
Totai Sq. Ft of Construction,: Sq. Ft. of First Floor:
Cost of Construction: $ d y?° ' Utilities: E]Sewer FSeptic Building Height:
OWNER/LESSEE:
Name 5c e_evi kunyW, �k.55 ecL Nicif
Address:) jSJS FCOMGn0 p1L.)
City: t W" PkerCR State: (`Q__�
Zip Code: 34Ci%-7 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company: `c(r,-ro tit A , r- Su S'LeYt5 ( �-
Address: reea
City: P02T St, L ri State: r
Zip Code: - q 5.1- Fax: `7 `7,?- J 3 5- I cf to Y
Phone No. 111 33S - 323 z
E-Mail: C L1 SteLIr Sys 4:�Ccal-CGvft
State or County License: C 4 C O 5( F I C7
If value of construction is $2500 or mo re, a RECORDED Notice of Commencement is required.
SUPPLEMENIALCONS IRUC IION LIEN LAW iNFURIVIAIION:
DESIGNER/ENGINEER: Not Applicable
i MORTGAGE COMPANY: Not Applicable
Name:
' Name:
Address:
Address:
City: State:
Cit+f: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City:
City
Zip: Phone:
up: Phone:
I certify that no ;work or installation hzis commenced prior to file issuance of a permit_
St_ Lucie County makes no representation that is granting a permit L_.,ill authorize the permit holder to build the subject structure
vdik:h is in conflict with any applicable Home Owners Association rules, b..la>•rs orand covenants that may restrict or pr ehibit such
structure_ Please consult :nth your Home 0,omers Association and review your deed for any restrictions >•ihich may apply_
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perforrn tie v-,ork
in accordance e.ith the approved plans, the Florida Building Codes and St_ Lude County Amendments.
The folio Ang building per n it applications are ekeniptfrom undergoing a full concurrency review: room additions,
accessow structures, swimming pools, fences, L«a ls, signs, screen rooms and accessoR, uses to another non-residential use
WARN ING 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 lobsite
before the first inspection. If }lou intend to obtain financing, consult taiith lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature ofOE-,-nor/_essee/Cantractoras Agentfor O:L ner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this l,; day of Qr>ti1 �� 10 /� bt
(Name of person acknowledging )
Signature of Contractor/License Holder
STATE OF FLORIDA r: ;
COUNTY OF _ �• . .
The forgoing instrument Leas ackno�.ledged before me
this %dal �f M l by
(Name of person acknowledging)
(5ignature of Notary Public- Star oaf Pc da) ( (Signature of Notary Public- State e .- cdd*,—,;
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Produced f Type of identification Produced
-YPu°�
CF?rtlSTa' `,`: S}t
Commission No_ ., - YP
4fhmission
CHRISTiNEBEN
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Reused G" i 15i 2014
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EXPIRES: AMU 4.2071
REVIEIAIS
FRONT ZONING SUPERVISOR i VEGETATION
SEaTURTLE
ryi.ANGROVE �
COUNTER REL'IEtN F REVIEW REVIEW REVIEW
i REVIa,%'
REVIEW'
DATE
—PLANS
COMPLETE
INITIALS
_
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida County of St. Lucie
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes,
the following information is provided in this Notice of Commencement.
Legal Description of Property: (and street address if available):
S+ lve;e. t✓'yon4�1 - Seek:(5n o9 01w- 3(O5 396
General description of improvement: R\J 4 C-
Owner information or Lessee information if the Lessee contracted for the improvement:
Name " ; o- iC
Address 1150S eCiLlom,00rL, F o (--a C L.--3,Ack
Interest in property: (1sOS fb6JnMtr10 lA'Z 'FOi' k- Me_ �L
Name and address of fee simple titleholder (if different from Owner listed above):
Contractor's Name:
Contractor Address;
Surety (if applicable, a copy of the payment bond is attached): Amount of bond: $ tq A
Name and address: Phone number:
Lender Name:
Lender's address:
hone Number:
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by S
713.13(1) (a)7., Florida Statutes:
Name: ��'75 iC_CA �f `� Phone Number: n - • g C1y- q q 81
Address: 1L50g-rl fb-A A-ZA-O 1-3a- i~or*,�fM l t_ 3lk9-6:'
In addition to himself or herself, Owner designates
Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes.
Phone number of person or entity designated by owner:
of
to receive a copy of the
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor, but will be 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of
my knowledge and belief. ,
O��gY
(Si 0ature of Owns or Lessee, or Owner's or Lessee's Authorized Officer/Director/Partner/Manager a
Owl)
(Signatory's Title/Office)
The foregoing instrument was acknowledged before me this day of20-b
By � /Naa C 1 Cc -,Cc -,me of P i
as oW1)ci
Type of authority (e.g. officer, trustee)
'T
JAMES JARVIS
* MY COMMISSION # GG 060115
EXPIRES: May 5, 2021
9ondtd firu Budget Notary Services
for
F)bL h{2,o0-Yz2-�s-67d-�
Party on behalf of whom instrument was executed
Personally known_ or produced Identification
nature of tary Public - State of Florida)
nt, Type r Stamp Commissioned Name of Notary Public) Type of Identification produced 14 D ,!
y200 - yzz- 7S•-67o-0
Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952
(772) 335-3232 • Fax( 772) 335-1968
Proposal and Agreement
Customer Name S� 1c A � � /I/ C�� Phone T �� �� y y o � �� Date f ^ //~/ I
Address eAl omyto v O Job Address
City, State, Zip K, Pjer,(t ILL .3 Mr7 Work Phone(s)
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal.
Equipment Specifications
Make J '1 P'rG Model Number(s) Y� 7060
SEER 7 EER AFUE Btuh Cooling Btuh Heating CFM
e: L./lec_ Jls- Lllce s"Tan !6 �Ce_(' CAAIISc. opt`.
P(Jtc nC-4o0P3 : //?► s, Fe(-Z" 1 t V- - <SUAr, /a8tc Y T'
1S ZVreof-l�, G_ o"A ��4.r/f�l � 174-,.,AT SwCrCll, N)tsG ^Wr,r1Asa
❑ New Amp disconnect
❑ New Amp electric service
❑ New low voltage wiring
❑ New weather resistant equipment stand
❑ New reinforced equipment pad
❑ New vibration isolation pads
❑ New properly sized refrigerant lines
❑ New clean, dry ACR copper tubing
❑ Insulate refrigerant suction line(s)
❑ Install refrigerant drier(s)
❑Evacuate refrigerant system
I Charge to manufacturer's specs
Z? Meet all federal, state & local laws
❑ Option (below)
Remove existing equipment from premises
Install energy saving setback thermostat
❑ New copper wire from to
[ Make air tight plenum transition
❑ new supply diffuser(s)
❑ New duct run from to
❑ Noise reducing flexible duct connector
❑ Balance for uniform supply air distribution
❑ Provide for external combustion air
❑ New gas piping from to
❑ New vent pipe and cap
a Clean work area to customer's satisfaction
q' Condensation overflow safety switch
U Hurricane Fasteners for outdoor unit
n
u
U
X in boxes = Yes
❑ New condensate drain system
❑ New condensate pump
❑ Install aux. condensate drain pan
❑ New high efficiency air filter
❑ New humidification system
❑ New return air filter grill
UlMeet all code requirements
Co lete system start up
❑ year parts warranty
❑ �_ year labor warranty
❑ A_ year compressor warranty
❑ year service agreement
p1✓/��r�A' /t�lSTrrcf�
Total Investment $
Taxes $
Total Amount $
Down Paymeat
Balance Due $
Terms:
Accepta ce Customer) Ap ^
O
B Date By
Date �/ r