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HomeMy WebLinkAboutCusato Craig 4 ton Rheem AC change-out 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 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line sr.z N 69611111111M Address -f Legal Description: Property Tax ID #: s�1 J(, (l U�J��� '� Lot No.� Site Plan Name: Block No. Project Name: ruwjp Setbacks Front Back: Right Side: Left Side: ne-OcItnhalC.. rnaor to e e orme un er t is permit — c ec a appy: 7Gas Shutters Q Windows/Doors Gas Tank Piping _ Electric 0 Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: S Ft. of First Floor: OSeptic Cost of Construction: $ ,� Utilities:0Sewer Building Height: Name: `� Company�tf% _ 7.777 r) f �-44 State: �j Address: 15 c 6i� D I ex Fax:—�% 72 �q '�`�7i� City: Phone No.�%Z z_c� Zip Code: /i Fax- State: 7-M-326 E -Mail: Ole Phone No. %2390 _g2LC Fill in fe simple Title Holder on next page ( if different E -Mail: �i5r'Jd'i1 b'1 from the Owner listed above) State or County License:1�40(I_ © /�C n C��-I If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. IMAM 990902 020 PM 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 is in bylaws which conflict with any applicable Home Owners Association rules, 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing/work or recording our Notice of Commencement. A /? ; Signa(bof 0 er/ Lessee/Contractor as Agent for Owner Signa, f Contractor/License Holder /j ; ST FLORIDASTATE OF FLORIDAI COUNTY OF I (,s C� f' COUNTY OF The forgoing instrument was acknowled before me day i 20 � by The forgoing instrument yras acknowledg d before me this" 1 day of U I'(d 7 2 e by this of �x��LC Name of pe rso making statement Name of pers making statement Personally Known J OR Produced Identification Personally Known I OR Produced Identification Type of Identification Type of Identification Produced Produced 3 :`'•. CRAIG A. GROSSMAN CRAIG A. GR N9Y COMMISSION # FF990902 Yj '= MY COMMISSION XPIRES May(Signature of Notary Public- State � a � � F$~otatyS9 1 EXPIRES M" Agnatu a of Notary Public- State IA ,13 F ' D, Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED _ Rev. 8/2/17 IMAM 990902 020 PM