HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8/2/2020 Permit Number:
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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: 5061 N Highway A1A , Unit 704 Fort Pierce, FI 34949
Property Tax I D #: 1414-601-0038-000-4
Site Plan Name: 5061 N Highway Al Unit 704
Project Name: A/C Change Out
DETAILED DESCRIPTION OF WORK:
A/C change out. Replace existing 3 ton split A/C with new 3 ton 14 SEER split A/C.
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic
Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Sandra Clark
Name: Anthony Fenn
Address: 5061 N Highway Al Unit 704
Company: Assured Air Conditioning
City: Fort Pierce State: _
Zip Code: 34949 Fax:
Phone No. (772)242-1752
Address: 278 NE Surlside 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
11 YUIYC VI I.VIIDII YI.UuII n cauu ur more, a KrFcurcutu Notice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
8
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
_ Not Applicable
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
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 ssee/Contractor as Agent for Owner
Signature of icense Holder
STATE OF (1
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COUNTY OFORIDA
L, L e-
COUNTSTATE
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SwoJn to (or affirmed) and subscribed before me of
Swor (or affirmed) and subscribed before me of
/ Physical Presence or Online Notarization
Physical Presence or Online Notarization
this _01 day of 2020 by
this -a day of 2020 by
Name of person niiiaking statement.
Name of person makirM statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
M
Produced
aemlii
(Signature of Notary toe f i ) '
t�t��u��c -state of Florida
(Signatu e of Notary Public- State 61 F MARIA D.
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Commission No.lhtn •o `M Comr les Feb 4, 2023
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DATE
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DATE
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CV. 7/o/LU
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rl otary Assn.