HomeMy WebLinkAboutPermit application KassaALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9/15/2020
COUNTY
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential x
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 2840 Eagles Nest Way, Port St Lucie, FL 34952
Legal Description: Eagles Retreat at Savanna Club Phase 2
P ro pe rty Ta x I D #: 3424-702-0151-000-9
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
Change out like for like 4 ton package unit, 14 SEER, I OKW heat, Carrier package unit 50ZPCO48
CONSTRUCTION INFORMATION:
A rti1! 1151 work to 5e�ej orme un er t rs permit — cneCK all apply:
10HVAC L_J Gas Tank Gas Piping 11 Shutters a Windows Doors ,
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ $5000.00
OWNERAESSEE:
Name Lawrence and Donna Kassa
Sq. Ft. of First Floor:
Utilities:Sewer Septic Building Height:
Address: 2840 Eagles Nest Way
City: Port St Lucie State: FL
Zip Code: 34952 Fax: nla
Phone No, 914-405-1286
E-Mail: Lmkassa@hotmaii.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: Keith Thompson
Company: AC Keith Inc.
Address: 690 SW Pueblo Terrace
City: Port St Lucie
Zip Code: 34953 Fax: nla
Phone No. 772-519-1351
E-Mail: ackeith1@att.net
State or County License: CAC1813976
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
State: FL
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City:
Zip: Phone
FEE SiMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
—Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that nyo work or installation has commenced prior to the issuance of a permit.
ie
which is noconflic makes no
any applicable Home thatis
Asssocationir les,abylaws or and covenants enantss that build
drestrict 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencin ork or rec rd our Notice of Commencement
ure of Owner/ Less ee/C ractor as Agent for Owner
STATE OF FLORIDA
COUNTY OFF,
The forgoing instrument was acknowledged before me
this 11'�_ day of 20,0 by
Name of person making statement /
Personally Known OR Produced identification V
Type of Identification
Produced D,2-n0, 1)� �r-'e '_- --its c---%e—
(Signature of
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev. 812/17
BELINDA W. SUTCIFFE
Notary Public • 5(8eatylorida
Commission # GG 951651
My Comm. Expires Apr 17, 2024
re of Contractor/Licens older
STATE OF FLORIDA
COUNTY OFF;
The forgoing instrument was acknowledged before me
thisJ"� day of - 203Zg b
'J Y
Name of person making statement
Personally Known OR Produced identification —
-
Type of Identification
Produced Lo—a—, „4 r
(Signature of
;:� rrU• BELiµ4AW.SUT(JFFE
Commission No. _ Notary Public - 5t1te of Florida
-� mission # 0"1Y51
My Comm. Expires Apr 17, 2424
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW