HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/05/2019 Permit Number:
•
4
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 xxxx
PERMIT TYPE: Mech
PROPOSED IMPROVEMENT LOCATION:
Address: 10112 Mill Pond Lane
Property Tax ID 4: 2303-211-0025-000-05 Lot No.
Site Plan Name: Golden PondFyfe Residence Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Like for like Packagfe unit replacement
2.5 ton/10 kw114 seer/Ground
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; Sq. Ft. of First Floor:
Cost of Construction: S 4900.00 Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Pershing Mobile Home Sales Inc
Name:Don Miranda
Address:901 NW 31st Ave
Company: Miranda Plumbing & Air Conditioning
P Y�
City: Pompano Beac State: _
Zip Code: 33069 Fax:
Phone No.
Address:750 NW Enterprise Drive
City: Port St Lucie State:fl
Zip Code: 34986 Fax: 772-621-2885
Phone N0772-878-5123
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
�� .n�uc a,� wreo4ru�uurr ra Mw)UV Vr m4fe, d KMVKUCU Notice Cl 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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State: i
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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' LEIIIOER OR AN ATTORNEY BEFORE RECORDING OTICE OF ENCEMENT"
Signs ure o Owner/ Lessee/Contractor as Agent for Owner
Sign ontractor/Licerise Holder
STATE OF FLORIDA
STATE OF FLORIDA
CO U NTY O F st Lucie
COUNTY O F st u,ae
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this IS dayof ^"' 20''5 by
this J+' day of '`° 20-fs 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
(signature of Notary Public- States 1 Florida
(Signature of Notary Public- St a) L06 Diodat0
� ��!y Lori Diodato
Commission No. 3?' �$�InmlSSliXI # GG0692
= �= Commission # GC069
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ammission No. �I4t�es. Feb. 9,
±#: _ Expires: Feb. 9, 2
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REVIEW
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DATE
COMPLETED
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