HomeMy WebLinkAboutBuildilng Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5/4/2020 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 APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 9112 Pumpkin Ridge, Port St Lucie, FL 34986
Legal Description: PGA (Maidstone)
Property Tax ID #: 3322-505-0013-000-2
Site Plan Name:
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: I
Change Out like for like 4 ton unit, 16 SEER,1 OKW heat, Carrier Condenser 24APB648AO03, Air
Handier FB4CNP0481_00
CONSTRUCTION INFORMATION:
AdclMonal work toe nertormed un ert is permit—checka appy:
P4HVAC Gas Tank E]Gas Piping _ Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers ❑ Generator E]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ $5200.00
S Ft. of First Floor: _
lltilities:Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Donald and Lily Liang
Name: Keith Thompson
Address: 9112 Pumpkin Ridge
Company: AG Keith Inc.
City: Port St Lucie State:FIL
Zip Code: 34986 Fax: n/a
Phone No. 301-792-0031
Address:
City: Port St Lucie State: FL
Zip Code: 34953 Fax: n/a
Phone No. 772-519-1351
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: ackeithl@att.net
i
State or County License:. CAC 1813976
If value of construction is $2500 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:
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, 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 lobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording; your Notice of Commencemeriit. ,/ 7
Rev. 8/2/17
1k,
4,, �ri
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Si ature Owner/ L see/Cont ctor as Agent for Owner
Signature of Contractorf icense er
STATE OF FLORIDASTATE
COUNTY OF �,7 leu
OF FLORIDA /
COUNTY OF C,(/
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this" day of 1-eA � 20 2o by
this Y day of /L/ e.a 20 2O by
�4-X �r3m�vti
�/1C�fyy SC��
Name of person making statement /
Name of person making statement
Personally Known / OR Produced Identification
Personally Known �` OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida }
(Signature of Notary u Ic- .
_.o 1nog4,-. PHYLLIS ANN TANNA
Commission NO. Notary Pub(ISeaj)te o! Florida
Commission No. tpkY Pve''.. PHYLLI(SCIS'ANNA
or'r�dC_ Commission K GG 364293
n'. Notary Public - State of Florida
My Comm. Expires Aug 8, 2023
✓�' Commission # GG 364293
M
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DATE
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DATE
COMPLETED
Rev. 8/2/17