HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9-17-19 Permit Number:
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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 X Residential
PERMITTYPE: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 4180 N Hwy A1A, Unit 401 B
Property Tax iD #: 1423-506-0095-000-7
Site Plan Name:
Project Name:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: I
Like for Like AC changeout 5 ton 14 seer 10kw
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
— Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: S $4,800.00
Sq. Ft. of First Floor:
Utilities: _ 5ewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Addison Chess
Name: Shyan Wojtczak
Address: 4180 N Hwy Al A, Unit 401 B
Company: Cool Air Solutions of Floridan, Inc.
City: Fort Pierce, FL State: _
Zip Code: 34949 Fax:
Phone No. 772-801-1292
Address: 6903 Cabana Lane
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-801-5398
Phone No 772-634-0491
E-mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail coolairsol@gmail.com
State or County License CAC# 1819009
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.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
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 Coun" rnakes na representation that is granting a perrnit will authorize the permit holder to build the subject structure
which is in conflict with any apphcable 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,
accessary 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 FINANCIIIIG, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature d0wnerf Lessee) tutor as Agent for Owner
Signature of'C-ontractorf LiceK&e' der
STATE OF FLORIDA,__.
COUNTY OF �)y L C'i „ ., .
STATE OF FLORIDA
COUNTY OF C c e-
The forgoing instrument was acknowledged before me
this _L:J�Aday of 2019 by
The forgoing instrument was acknowledged before me
this [_)'"dayof '3c-P-� 26jn by
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Name of person making statement.
Name of person making statement.
Personally Known '- --- OR Produced Identification
Type of Identification
Produced
Personally Known ---OR Produced Identification
Type of identification
Produced
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EXPIRES April 43, 2D2t
Commission No. Seal
(Signature
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COM P L5TED
Rev, 211/19