HomeMy WebLinkAboutBuildling Permit Application,
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: MECHANICAL
Address: 8917 CHAMPIONS WAY
Permit Number:
Building Permit Application
Commercial Residential X
Property Tax ID #: 3334-501-0031-000-9 Lot No. 17
Site Plan Name: HATFIELD, MARK Block No. A
Project Name: HATFIELD, MARK
LIKE FOR LIKE A/C CHANGE OUT - 5TON 16SEER 10KW - CBA25UHV-060 / XC16SO60
Additional work to be performed under this permit —check all that apply:
XMechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:.
Cost of Construction: $ 8202
Name HATFIELD, MARK
Address: 8917 CHAMPIONS WAY
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
City: PORT ST LUCIE State: FL
Zip Code: 34986 Fax:
Phone No. 518-466-1095
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: JOSE RAMIREZ
Company: EAST COAST MECHANICAL
Address: 1500 N HIGH RIDGE RD
City: BOYNTON BEACH State: FL
Zip Code: 33426 Fax: 561-493-2701
Phone No 561-586-3739 EXT 2020
E-Mail PERMITS@ECMSERVICE.COM
State or County License CAC036812
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.
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 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, 1 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 IINTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signatur o wner/ Lessee/Co ract as Agent for Owner
Signature C tractor/License H tn
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF PALM BEACH
COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
20by
th' 28 day of�JAHUARY 20by
this 28 day of JANUARY 20
�Um C
Jose t e
JOSE RAMIREZ
Na of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification CHUCK
Type of Identification
Produced �pUBLIC
Produced CHUCK
PUBLIC
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°I, NOTARY
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t STATE OF FLORIDA
(Sign ture of Notary Public- of Fr&M7
(Signs re of Notary Public- 10 4172M
Commission No. (Seal)
Commission No. (Seal)
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COMPLETED
Rev. 2/7/19