HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
c� LaCG
fti Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: ABC Change Out
PROPOSED IMPROVEMENT LOCATION:
Address: 4901 F'alm Ave. Fort Pierce, FI 34982
Property Tax ID #: 3402-608-0169-000-1
Site Plan Name: 4907 Palm Ave.
Project Name: A/C Change Out
DETAILED DESCRIPTION OF WORK:
Remove 2 ton package unit. install 2 ton 14 SEER split A/C system. .,S
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No. 25
Block No. 43
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 4580 Utilities: —Sewer —Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Dorothy Williams
Name: Anthony Fenn
Address: 4907 Palm Ave
Company: Assured Air Conditioning
City: Fort Pierce State: _
Zip Code: 34982 Fax:
Phone No. (772)465-3610
Address: 278 NE Surfside Ave
City: Port St Lucie State: FI
Zip Code: 34983 Fax:
Phone No (772)202-2005
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail anthony.fenn@assuredairconditioning.com
State or County License CAC1820274
-- -• '-" G WnULU ivUuce or wmmencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
SIGNER/ENGINEER: Not Applicable
FP
MORTGAGE COMPANY: Not Applicable
me:
Name:
dress:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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.
Signature of 0 ssee/Contractor as Agent for Owner
Sign a ntractor/License Holder
STATE OF FLORIDA
COUNTY OF �2
STATE OF FLORIDA
COUNTY �-
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OF c�
Sworn,(or affirmed) and subscribed before me of
Sworn (or affirmed) and subscribed before me of
_ Physical Presence or Online Notarizationxsical
This day of k L�- 2020 by
Presence or Online Notarization
'
-02i f ,
this --0 day of a J()'— 2020 by
Name of person making statement.
Name of person mak g statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification rr
_G
Type of Identificatio
Produced V
Produced
(Sign ure of Notary Pu
iRl" '". MA IA D. GOMEZ
(Signatu a of Notary Public- Stat
ofArri4a) MARIA D. GOMEZ
Commission No. Notaryy��Public State of Florida
p GG 297951
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