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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST 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 XXX PERMIT TYPE: Address: 1701 Primrose CT Property Tax ID #: 3426-703-0154-000-9 Site Plan Name: Project Name: Jason L & CarelaDeRoy A/C Change Out Carrier 4Ton 15Seer 10KW Lot No.140 Block No. Additional work to be performed under this permit— check all that apply: Wechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Electric _ Plumbing _ Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ 5975.00 NameJason L DeRoy Address:1701 Primrose CT _ Generator _ Roof Pitch Sq. Ft. of First Floor: Utilities: —Sewer _Septic Building Height: City: Port ST Lucie State: rC Zip Code: 34952 Fax: Phone No. 772-342-4659 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Name: Jeffrey Lindstrom Company: Lindstrom Air Conditioning Address: 3581 W McNab Rd City: Pompano Beach State: FI Zip Code: 33069 Fax: Phone No 772-600-4088 E-Mail dulcem@lindstromair.com State or County License CAC056971 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. S1PPLME(�TAL CaN:STRUCT[C}N LIEN LAM/ INFC3RMAT,1©N °< ; 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 .Y0_Q INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NbTl E MMENCEMENT." S2 .Q �r`. Signature of Owner/ Lessee/Contractor as Agent for Owner Sig na = r "of Contra or/License Holder STATE OF FLORIDA ST . OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument pas acknowledged before me this day of 20_ by this IS day of La, ., 20_JJ by i S r Name of person making statement. Name of person mak' g statement. Personally Known OR Produced Identification Personally Known 0 OR Produced Identification ' Type of Identification Type o dentification ,PYP DULCEMARTINEZ Produced Prod ce Commission#GG103391 Expires May 10, 2021 �' e< Bonded Thru Budget Notary Sorvfm 0 1A (, (Signature of Notary Public- State of Florida) (Si na ure of Notary Public- State of Florida ) Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7 1