HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1213119 Permit Number:
COUNTY
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: t772j 462-1578 Commercial Residential x
PERMIT TYPE: MECHANICAL
PROPOSED IMPROVEMENT LOCATION:
Address: 210 SANDY BOTTOM PLACE A-07
Property Tax ID #: 3410-508-0007-000-6 Lot No.
Site Plan Name: Block No,
Project Name: ROSE CONLEY
DETAILED DESCRIPTION OF WORK:
HVAC LIKE FOR LIKE CHANGE OUT 3 TON 14.00 10 KW PACKAGE UNIT
CONSTRUCTION INFORMATION -
Acid itiona I work to be performed under this permit — check all that apply:
Zmechanical — Gas Tank _ Gas Piping _ Shutters Windows/Doors
— Electric _ Plumbing _ Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 5795-00 Utilities: _ Sewer _ Septic Building Height:
5 OWNER/LESSEE:
CONTRACTOR:
Name ROSE CONLEY
Name: FREDERICK MILLER
Address: 210 SANDY BOTTOM PLACE
Company: MILLER'S CENTRAL AIR, INC.
City: FT PIERCE State:
Address: 673 SW CARTER AVE
Zip Code: 349$2 Fax:
City: PORT ST LUCIE State: FL
Phone No. 772-882-4989
Zip Code: 34983 Fax: 772-344-6480
E-Mail:
Phone N 0 772-785-8080
Fill in fee simple Title Holder on next page I if different
E-Mail OFFICE@MILLERSCENTRALAIR.COM
State or County License CAC058675
from the Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAVA INFORMATION:
pE51GNER/ENGINEER: Not A#ipficable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Add ress:
City: State:
Zip: Phone:
Add ress:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
❑WNER/ 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.
5t. 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 con suit 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 5t. 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 YOUR NOTICE OF OMMENCEMENT."
Signat re of Owner/ Lessee/Contractor as Agent for Owner
5ignature of Con ractor/License Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF a - �,1.k[:I[ ,
COUNTY OF � Ltj-u(-
The fo gging instr p was acknowledg before me
this dday 20by
The fo�g�ing instrument was cknowledg before me
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Name of person making statement.
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Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(!Signature of Notary Public- State of Florida )
ignature of Notary Public- State of Florida
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Commission No. EL.M # FFgr�1459
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Rev. 1/ // 19