HomeMy WebLinkAboutPSL Hospital 10980 PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Q0LTN_L '^.
P L Co L� L `' `1 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:
Aririress. 10980 S Ocean Dr #312
Property Tax ID #: 4512-702-0009-000-2
Site Plan Name:
Project Name: PSL Hospital
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
Lot No.
Block No.
_ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _
Total Sq. Ft of Construction:
Cost of Construction: $ 4490.00
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name RMC Real Estate Holdings Inc
Name: Luke Walker
Address: 10980 S Ocean Dr #312
Company: Treasure Coast Air Conditioning
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No. 561-512-5311
Address: PO Box 460
City: Jensen Beach State: FL
Zip Code: 34958 Fax: 772-288-7046
Phone No772-691-1701
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:
City: State:
Zip: Phone:
Address:
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 recordine vour Notice of Commencement.
i
Signatur of 0 neV Lessee/Contractor as Agent for Owner
Signatu a of Co 'o
'cense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF AL el;iT/,c/
COUNTY OF
Swor to (or affirmed) and subscribed before me of
Physical Presence
Swo�rn�°"��orraaffirmed) and subscribed before me of
or Online Notarization
h` P ysical Presence or Online Notarization
this day of 2020 by
this day of .2020 by
Name of person making statement.
Name of person making statement.
Personally Known �OR Produced Identification
Personally Known L____'OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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