HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE � IN O MU T 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 IMPROVE MEN;T LQCATION
Address: f <� � � � f'U �.,-'�'i �� i -
Property Tax ID #: /1 /Z — f2v' �� Z/�1 —Cy3 Lot No.
cite PInn NAma• Block No.
Project Name:
Like for like AC replacement
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CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit— check all that apply:
✓Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 1%mil/ Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
.OWNER/LESSEE:
CONTRACTOR:
Name
Name: Steve Smith
Address: fTC�I� ���> /�o�r!' �/
City: %�� f'��i State: /-Z
Zip Code: S %5,T/ Fax:
Phone No.
Company: Steve Smith Air Conditioning
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 CAC1813454
If value of construction Is sz5uu or more, a KtLUKutu nonce of
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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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:
Zip: Phone:
City:
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 T E JOB BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Y LEND R N ATTORNEY BEFORE RECORDING YOUR NOTIC COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S ILU C.N F
STATE OF FLORID
COUNTY OF s •LUr f'
The forgoing instrument was acknowledged before me
this L`Iday of p t 4.0 , 204 by
The forgging instrument was acknowledged before me
this J day of M11,q 20� by
<�EVC0 �M ►-C4
( JJ''
Jft'uen S,� t4
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification _�
Type of Identification
Produced Dl?n\ VttL L I C_ &,-J S E
Personally Known OR Produced Identification k'
Type of Identification
Produced ►~L (� L
*na
ignat a of ota Public- State of Florid ChristopherJ.
NOTARY PU
Commission No. STATE OF
• 0 Comm# GG
f Notary Public- State o Flo ' Stephanie Mour
LIC h� NOTARY PUBLI
'08RAission No. �Fg�`�7JG l a STATE OF FLOI
2758 ?Comm# FF9573
's . "In; 9141911712(
01
1
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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