HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
aaCQLE
PLOL4* c- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 11000 S Ocean Dr #1 C
Property Tax ID#: 4512-701-0003-000-7
Site Plan Name:
Project Name: Otis
DETAILED DESCRIPTION OF WORK:
Install a new 2 ton 15 seer 5kw Rheem complete system
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 4480.00
Generator
Sq. Ft. of First Floor:
Lot No._
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name John Otis
Name: Luke Walker
Address: 11000 S Ocean Drive #1C
Company: Treasure Coast Air
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No. 508-472-8034
Address: PO Box 460
City: Jensen Beach State: FL
Zip Code: 34952 Fax: 772-288-7046
Phone N0772-692-1701
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailTCAC1990@att.net
State or County LicenseCAC058476
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC 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:
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 thepermit 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with le.n.der or an attornev before commencing work or recorsiine vour Notice of Commencement.
Signa o ner/ Lessee/Contractor as Agent for Owner
Contractor/License Holder
=OF
STA O LORIDA
COU OF /�%ti /MAJ
FLORIDA
COUNTY OF
Swo to (or affirmed) and subscribed before me of
Sworn o (or affirmed) and subscribed before me of
Physical M -or Online Notarization
Physical Presence or Online Notarization
this - day of 2020 by
this __I_ day ofaj&Z 12020 by
Name of person making
Name of person making statement.
statement.
V
OR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
llllllllll/
\�\\\11tN11tNll!/����i
(Signature gKotary P lic- State of Flori`d�� . • p qi��i
(Signature of Wotary Public- State of Flore
\
Commission No. .(Sed\�,•:
Commission No. '.
REVIEWS
FRONT
ZONI o o %Uq�*GoP��,E�ee(,!� "PLANS
VEGETATION
SEA TURj. •'���
COUNTER
REVIE*? •?;'�] c`t1�1;Q•'�o
�AEVIEW
REVIEW
W�ii�
REVIEDATE
�/C�\\\���``
/lIIIIIIININ\\\
RECEIVED
pl
DATE
COMPLETED
nev. D/ o/ /-u