HomeMy WebLinkAboutROLAND CU CHANGE OUTAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: DECEMBER 9, 2019 — Permit Number:
J _i
11
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 x
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION: 1
Address: 10751 S OCEAN DR B1. JENSEN BEACH FL 34957 —
Property Tax ID #: 4511-311-0030-000-5
Site Plan Name:
Project Name: ROLAND A/C CHANGE OUT
Lot No.
Block No.
DETAILED DESCRIPTION aF WORK:
INSTALLATION OF ONE 3.5 TON 14 SEER AMERISTAR CONDENSING UNIT ONLY. R410A REFRIGERANT.
LCONST6CTION INFORMATION;
Additional work to be performed under this permit — cheek all that apply:
—Mechanical _ Gas Tank _ Gas Piping — Shutters , Windows/Doors
Electric — Plumbing _ Sprinklers — Generator _- Roof __ Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2,200.00
Sq. Ft. of First Floor:
Utilities: __. Sewer —. Septic Building Height:
OWNER/LESSEE:------- ------ -- - --
Name Lynda C Lynn
Address: 2641 SW Tanforan BLVD
City: Port St Lucie, FL State:
Zip Code: 34987 Fax: _^
Phone No. 908-461-2633
E-Mail: N/A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: JUAN MIGUEL CRUZADO
Company: JENSEN BEACH AIR & HEAT LLC
Address: 2092 SE HANFORD RD
City: PORT ST LUCIE State: FL
Zip Code: 34952 Fax:
Phone No 772-334-3200
E-Mail JENSENBEACHAC@GMAIL.COM
State or County License CAC1818779
- - -' -- --. --•• •• •� r. �. ...�� �, o 'W"Uw ivuuGe u, Lummencemenic is requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
` �TRLlCT ON LIE LAW INFORMATION:
DESIGNER/ENGINEER: � Not Applicable
MORTGAGE COMPANY:
Name:
Address: _
City: State: _
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
Name: ----
I Address:
City: ------- --____
Zip: Phone:
-___ Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 PAYINC,
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, CONSUL -
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA — ` ( L U
COUNTY OF c
The o g ing ins ru dge ore me
this day of . y
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Name of person making statement.
Personally Known OR Produced Identification _
Type of Identification — ^
Pro c
(Signature of Notary Publicate of Florida )
Commission No. �"wt/I pAARIE. �R!
C i4 FF99:
nnY OOMMISS N
Si atu of Contractor/License Helder
S ATE OF FLORIDA
COUNTY OF`_ . LA J� ,
The i'ti ng inst uf�rrf c edge %, me
this ( day of 1J // �� ��[ 11 �n ,
Name of person maki7statement
Personally Known _ OR Produced Identification
Type of Identification
Produced
igriature of Notary Publi . ate of Florida }
O
mrnission No
..evS� P�-M G�CSN # �F9920
REVIEWS FRONT G OR PLANS f T f�' ANGROVE
COUNTER "� --REVIEW REVIEW I REVIEW
DATE noys�'0�
RECEIVED
DATE ----- -- - ---- — - __. —� _
COMPLETED