HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -T 1 $ ' [ "1 Permit Number:
0NT
E L O R I V. A'
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 7094 Torrey Pines Cir
Property Tax ID #: 3322-504-0014-000-6
Site Plan Name:
Project Name: Derle-Residence
DETAILED DESCRIPTION OF WORK:
Like for Like A/C System Replacement
3 ton, vertica/ground, 14 seer, 5kw
CONSTRUCTION INFORMATION:
Building Permit Application
Commercia
Residential xxxx
Lot No.
R]M.WO"o
Additional work to be performed under this permit — check all that apply:
L Mechanical _ Gas Tank — Gas Piping _ Shutters _ Windows/Doors
_._. Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 6230.00
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Donald F Derle
Name: Don Miranda
Address:7094 Torrey Pines Cir
Company: Miranda Plumbing & Air Conditioning, Inc.
City: Port St Lucie State:
Zip Code: 34986 Fax:
Phone No.
Address:750 NW Enterprise Drive
City: Port St Lucie Stater
Zip Code: 34986 Fax: 772-621-2885
Phone No772-878-5123
E-Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E-Mail Ldiodato@mirandacompanies.com
State or County License CAC1815486
If value of construction is 52500 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:
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 F COMMENCEMENT."
Si e of Owner/ Lessee/Contractor as Agent for Owner
atu tractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFSTLUCIE
COUNTY OFSTLUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of `� -r � 20 : by
this " day of 20 ,r� by
Don Miranda
Don Miranda
Name of person making statement.
Name of person making statement.
Personally Known — OR Produced Identification
Personally Known — OR Produced Identification
Type of Identification
Type of identification
Produced
Produced
i
(Signature of Notary Public- State of Florida)
(Signature of Notary Publi ,Floridthu
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REVIEWS
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SUPERVISOR
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DATE
RECEIVED
DATE
COMPLETED
Rev. 217/19