HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
5 J r��l
•
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 >/1
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: a22/� 22K
Property Tax ID #: -119V - - Cif3f% -y Lot No. G
Site Plan Name:��>�7lib Z��?%:f /%/f/ I Block No. _77_
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: /l Sq. Ft. of First Floor: _
Cost of Construction: $ — Utilities: -Sewer _Septic
Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name ;'
Name:
Address: A-Z 2-q Cfi✓� �'�P J
Company: I
City: �E�1� . lU�:%t'i State:
Zip Code:Fax:
Phone No.� / C--- <f�U - 2 310
Address: -129lei
City:f��1/%, ll�l�1� State:��
Zip Code: - f4 %'Y 2— Fax:
Phone No <JaL -% 41
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail�q,//J
State or County License L f l_'>
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:
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, 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."
Si of Owner/ Lessee/Contractor as Agent for Owner
Sign Contractor/License Holder
STATE OF FLORIDA
3
STATE OF FLORIDA
;S-r t CouJ l�
COUNTY OF T L.v ci C Cau,.,`��,
COUNTY OF ocfL-
The f��.jjgoing instr ment was acknowledged before me
The foing instrument was acknowledged before me
I
this "! day of L 20.a by
this day of 1 L 20 2a by
Name of person making statement.
Name of person making statement.
/
Personally Known ✓ OR Produced Identification
Personally Known y.-� OR Produced Identification
Type of Identification
Type of Identification
Produced
IMAL ()L )0. L
Produced
b ) 'J,4_�
(Signature of Notary Public- State of Florida)
(Signature of Notary P, lic- State of Florida )
C
A ALSH
Commission le
ANDRA SH
te of Florida -Notary Public
State of Florida -Notary Public
=* ra
ommtssion
i"6miiii
197984
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SUPERVISOR
PLANS
I
E q° s 20LPRAJR
E
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
1578 Niemeyer Circle
Port St. Lucie, FL 34952
Clean. ,Air
11-eclincicaties
PROPOSAL AND AGREEMENT
A/C Sales Service Installation
By Jeffrey Almeida - Lic # CA-0058660
CUSTOMER NAME
ADDRESS
CITY, STATE, ZIP -
(772) 335-2061
Fax 335-1802
PHONE_�C
JOB ADDRESS. �ZP_
WORK PHONE
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on all pages
of this proposal.
EQUIPMENT SPECIFICATIONS
Make ki-twi -l-ra Model Number(s) 4 C�� - lnvA
SEER EER BTUH Cooling � BTUH Heating , tJ CFM
Installation shall
include:
New Amp disconnect
New low voltage wiring
New reinforced equipment pad
New vibration isolation pads
New properly sized refrigerant lines
New, clean, dry ACR copper tubing
Charge to manufacturer's specs
Insulate refrigerant suction lines
Install refrigerant drier(s)
Evacuate refrigerant system
Remove existing equipment from premises
Install new thermostat
New copper wire from to
Complete system start up
Option (below)
Terms:
Acceptance by:.
Date
X = Yes
Make air tight plenum transition
New dehumidistat
New supply diffuser
New duct run from to
New return air filter grill
Noise reducing flexible duct connector
Clean work area to customer's satisfaction
New condensate drain system
Install aux. condensate drain pan
New high efficiency air filter
Meet all code requirements
.year parts warranty
1 year labor warranty
_Lyear compressor
_year service agreement
Alternative (below) Is ( _ Is not) included in price
Approved
by:
Installed Price $ W
Taxes $
Total Amount $
Down Payment $
Balance Due $
Date: �LK ( ::->
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