HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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 x
PERMIT TYPE: a/c change out
Address: 9960 S OCEAN DR #1701 JENSEN
Property Tax ID #: 4502-702-0071-000-6
Site Plan Name:
Project Name: DALENE
FL 34957
A/C CHANGE OUT EER14.70 2.5 TON HEAT PUMP 0 KW
Additional work to be performed under this permit- check all that apply:
A Mechanical — Gas Tank — Gas Piping — Shutters
Lot No.
Block No.
Windows/Doors
— Electric — Plumbing — Sprinklers — Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 5,372,00 Utilities: —Sewer _ Septic Building Height:
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.
Ar -ON 111
M "EM M
"Iffla, NOW R
Name THELMA DALENE
Name: THOMAS RANGER
Address: 9960 S OCEAN DR #1701
City: JENSEN BEACH
Zip Code: 34957 Fax:
Phone No. 860-250-9473
E -Mail:
-State: FL
Company: RANGER AIR CONDITIONING
Address: 9845 SE FEDERAL HWY
City: HOBE SOUND State: Fl
Zip Code: 33455 Fax: 772-546-0322
Phone No 772-546-7777
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail MORGAN@RANGERAC.COM
State or County License CAC009726
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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64545
PIN VIII I
NO 11 wl�
IN
MORTGAGE COMPANY _ Not Applicable
DESIGNER ENGINEER: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
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 instailation 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:
bylaws that may, restrict or such
which is in conflict with any applicable Home Owners Association rules, or and covenants prohibit
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 lmlll; in all respects, perform the work
in accordance with the approved plans, the Florida Building E odes and St. Lucie CountyAmendnients.
The following, building permit applications' are exempt from undergoing afull concurrency review: room additions;
accessory: structures, swimming- pools; fences; walls, signs, screen rooms and accessory uses to another icon -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 RECORDEDAND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND tb► OBTAIN FINANCING, CONSVILT
WITH YOUR LENDER OR AN ATTORNEYBEFORE RECORDING Y UR NOTICE_OF COMMENCEMENT."
Signature of Contractor/License Holder°
ignature of Owner/ Lessee/Contractor as Agent for Owner
STATE. OF FLORIDA
STATE OF FLORIDA
COUNTY OF II r-
COUNTY OF Mg,A-r,
The forgoing instrument. was acknowledged before me
this a -1 day, of Sa„ua., . 2a2U by
The forgoing instrument was acknowledged before me
this 21 day of --Tarnuo.r y 2020 by
S CZCak n 0, R.
0,"1 \ZGlnac
Name of person making statement.
Name of person making state t.
Personally Known OR Produced Identification
Type of identification
Produced
Personally Known A OR Produced' identification
Type of Identification
Produced
(Sighattfirerof Notary Pubfic- State of Florida l
(Signature` f Notary. Pubfic- State of Florida: I
Commission No. G%� 3y S X155 ( rMMorgan
mesio : o: GG, 3 ` l 5 X15 j Notary Public S
tt Morgan L Ben G 345455 My commission
3
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REVIEWS
COUNTER REVIEW REVIEW
S
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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