HomeMy WebLinkAboutBuilding Permit ApplicaitonAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-16-19 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 X Residential
PERMITTYPE: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 4000 N Hwy A1A Unit 601
Property Tax ID #: 1423-503-0009-000-9
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK;
AC changeout like for like 5 ton 16 seer watersource heat pump
CONSTRUCTION INFORMATION:
Lot No._
Block No.
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:
Cost of Construction: $ 5,575.00
Sq, Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Tim & Marilyn Olson
Name: Shyan Wojtczak
Address:4000 N Hwy Al Unit 601
Company: Cool Air Solutions of Florida, Inc.
City: Fort Pierce, FL State: _
Zip Code: 34949 Fax:
Phone No. 612-747-4242
Address: 6903 Cabana Lane
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-801-5398
Phone No 772-634-0491
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail coolairsol@gmaii.com
State or County License CAC# 1819009
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 LAW INFORMATION:
DESIGNER/ENGINEER: .____ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name: I
Address:
Address: i
City: _ State:
City: State:
Zip: Phone
Zip: Phone:._
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 ru representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Horne 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 FINANCI NC, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
1� LL
`
Signature Owner/ Lessee/ ntraktor as Agent for Owner
Signature of Eantractor/License "der
STATE OF FLORIDA
STATE OF FLORIDA �.
�Z4
FCOUNTYOF I
The for Ding instrum nt was acknowledged before me
�C
The for Ding instrument was acknowledged before me
�
this l day of Zq� by
this I day of 3, 2012 by
L- 2 IC
Ot C
Name of person making statement.
Name of person making statement.
i
Personally Known —� OR Produced Identification
Personally Known '---OR Produced identification
Type of Identification
Type of Identification
i
Produced
Produced
i
i
tk+ R
LAN
ignature
{Signature
ubRJCM
EXPIRES? April [33, 2027
-' ;`= MY COML41SSION # GGQ89907
Commission No. Seal
Commission
EXPiRr-s April o3(�kaaW
REVIEWS
FRONT
i ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
l REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
[SATE
RECEIVED
p
DATE~
COMPLETED
�
ev.