HomeMy WebLinkAboutCalandrilo Michael - The MacKenzie Group - AC changeout permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
ci� 0 -
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:
Address:
PropertyTaxlD#:
Lot No.
Site Plan Name: -� Block No.
Project Name: ccndi(I I o - 74
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply:
`/Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name I `vU �1rll�ijG'C11�
Address Fsoq hl1)' )1tr
City: State:/
Zip Code r 2— Fax-.__7iZ'3q� _` 9777
Phone No. '�71 2 3 q tb
E-Mail: ��vDSSY)')/��►IIQ('_i4 r.nlfYlCii'5�n-e
Fill in fee'simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR
,N 8me: eJ/1-
D wo_nl
Company:
Y, Air ndi I
Address:
( i r a7
City:
Stater
Zip Code: �J
Fax-_2777- Z!
Phone No J
_ ' '7 25-
E-Mail DS5
n 4 coM ryeJ-
State or ounty License
CAA- b Ea �"S cl
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.
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DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
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 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 lender or an -attorney before commencing work or recording our Notice of Commencement.
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u
Si f Ow*' r Lessee/Contractor as Agent for Owner
W n Cont ac or/License Holder
STATE OF FLORIDA
COUNTY OF �� . �,(t t e
STATE OF FLORIDA
COUNTY OFe—
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _!5_ day of,-)Ajj2 � 12020 by
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _r2_ day of iLLP 2020 by
Name of person making statement.
Name of person making statement.
Personally Knowny OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Publi
Notary Public Stale of Fwtde
Commission No. CrA I A Grossrnan
tsswnGG983059
E Aires OSn 0/202a
(Signature of Notary Publi
�y� Notary Public State of Fw6da
ommission No. cra ossman
j My C—ammi $ton GG 983069
• randF Expires0500/202a
PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.