HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01/28/20
CdUNTY
F L 0 R' [- D A
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: HVAC
PROPOSED IMPROVEMENT LOCATION:
Address: 10701 S OCEAN DR 628
Property Tax ID #: 4511-805-0029-000-1
Site Plan Name:
Project Name: FAIR AC CHANGE OUT
Permit Number:
Building Permit Application
Commercial Residential X
DETAILED DESCRIPTION OF WORK:
LIKE FOR LIKE 3 TON AC PACKAGE UNIT CHANGE OUT WITH 10 KW AND NO DUCT WORK
/-/ '5'C—(7
CONSTRUCTION INFORMATION:
Lot No. 29
Block No.
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: $ 4100
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name IAN FAIR
Address: 10701 S OCEAN DR 628
Name: ROBERT CAMPBELL
Company: BUILDING TECHNOLOGY SERVICES
City: JENSEN BEACH State. FL
Zip Code: 34957 Fax:
Phone No. (865) 333-6822
Address: 5670 SE GROUPER AVE
City: STUART State: FL
Zip Code: 34997 Fax:
Phone No 772-600-7151
E-Mail: lesliekfair@hotmaii.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail DANIEL@BREATHEHEALTHIERAIR.COM
State or County License CAC058685
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY:
_,S,- Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _yNot Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City: City
Zip: Phone: Zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 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 FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Ownef7 Lessee/Contractor as Agent for Owner
Signature of Contra r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF MARnN
COUNTY OF MARTIN
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 28 day of JANUARY 20JD by
this ZB day of JANUARY 20& by
ROBERT CAMPBELL
ROGER r CAMPBELL _
Name of person making statement.
Name of person making statement.
Personally Known A-' OR Produced Identification
Personally Known k' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of otary Ublic- 3 IArida ) DANIEL ENGLAND
(Si tUre of N ary llc- Stat q a) DANIEL ENGLAND
Notary Public y blic -State of Florida
Commission No. Oc333a70 `. 'Cs ' LLyq�ryy�nissian=GG 73ID o
Ebthln. Expires May 13. 302
Notary Public, State of FI
ommisslon No. GGax�eTo ?C d,?iS�.,L9mmissian=GG 3338
"•?•n- mm. Expires
..,,rr:'
May 13.
Banded through Natima: Notary Assn
Bonged through National Notary
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