HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/18/19 Permit Number:
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Planning and Development5ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
PERMIT TYPE: hvac change -out
PROPOSED IMPROVEMENT LOCATION:
Address: ozi.ss t-nampions vvay, NSL, ;3496b
Property Tax ID #: 333450100350007
Site Plan Name:
Project Name:
Commercial Residential x
DETAILED DESCRIPTION OF WORK:
Replace existing 5 ton system with Ruud 5 ton 16.0 seer w110kw heat
{ CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
,Mechanical _ Gas Tank — Gas Piping _ Shutters
__._ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 4950.00
Sprinklers Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name George Cinquegrana
Name: Tracy Steele
Address:8933 Champions Way
Company: Tracy D Steele Air Conditioning Inc
City: Port St Lucie State:
Zip Code: 34986 Fax:
Phone No. 203-525-7636
Address: 2750 SW Edgarce St
City: Port St Lucie State: FI
Zip Code: 34953 Fax:
Phone No 772-215-1974
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail tdsac@aol.com
State or County License CAC035553
.c 1— — LIVI1 I� 17c7vV UI II JUTe, d RCLUKUrU rvorice oT lommencement 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:
i 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 Horne 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 NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C MENCEMENT."
Signature of Owner/ LVsee/CVra4actor as Agent for Owner
Signature of Con gctor/ ijcnse Holder
STATE OF FLORIDA
COUNTY OF S v
STATE OF FLORIDA
COUNTY OF 0) Ly 1
The forgoing instrument Was acknowledged before me
this ; ? day of v 20 �' � by
The forgoing instrument was acknowledged before me
this _,> day of LL1 E4Z ,1� . 20� by
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Name of pef4on making statement.
Name of person ma cing statement.
Personally Known _,�_OR Produced Identification
Personally Known OR Produced Identification
Type of identification
Type of identification
Produced
Produced
(Signature of Notary Public- State o a J
(Signature of Notary Public- State of Florida f
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Co OAlotary Public State of Florida Seal)
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My Commission GG 251653
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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