HomeMy WebLinkAboutBiulding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % 2U 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 Residential L
PERMITTYPE:HVAC Equipment ChangeOut
Address:
Property Tax ID #: / ��fy��— (� 7 Lot No.�
Site Plan Name: Block No.
Project Name:
Like for like AC replacement
Additional work to be performed under this permit– check all that apply:
-2/Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Nam
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Address:/dl/f/ �/ll�i
City: 1/5 /W/ State: /CL
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Steve Smith
Company:Steve Smith Air Conditioning
Address: 8001 Eden Road
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-461-2036
Phone N0772-461-1425
E -Mail stevesmithac@aol.com
State or County License CACI 813454
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.
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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:
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 thepermit 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 T E JOB fflTE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YqWLENDIII AN ATTORNEY BEFORE RECORDING YOUR NOTICEW COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA,
COUNTY OF !S—r- LU C_N F
COUNTY OF .s -Lu
The forgoing instrument was acknowledged before me
this �A7yday of �.v, 204 by
The forgoing instrument was acknowledged before me
this � day of %1�1/L�„ 20 �' by
<,-(-&V EN M% -T14
J ieue✓1 .S►,4- I A
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification _�
Personally Known OR Produced Identification )<
Type of Identification
Produced 17(1-\ VER. L I C &"J S E
Type of Identification
Produced �`�- u L—
ignat a of ota Public- -S-to of Florid Christopher J.r� nature it Notary Public- State of Flo { Stephanie Mour
NOTARY PLI 3LIC NOTARY PUBLI
Commission No. STATE OF 06RAission No. FF93-7-? l a a STATE OF FLOI Z11
Coram# GG 2758 Comm# FF95731 1
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
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