HomeMy WebLinkAboutSaladrigas William & Vivian AC changeout permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L:icil 11L5
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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: Q,� (:_; _Mqo
-ROVEM ENT LOCATION.
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Mm
Address:�ro ( by-1 V-e-
t
Property Tax ID #: / lrty " 50S - 06 - nQ 0
Lot No.
Site Plan Name: Block No.
a ,
Project Name:
LIU
: =ZC2-2 l(� �� lb c� ha.
New Electrical Meter Second Electrical Meter
Additigtial work to be performed under this permit - check all that apply:
echanical _ 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: $ Utilities: —Sewer _Septic Building Height:
CONTRACTO
Name 1 Name: J `_
Address: r Compan ^�Jli'IQO%i1 ,r l�1Ci t eT(�r
City: S State: Address: 26Sb•
Zip CTod-. Fax: City: C� State:_
Phon7i Zip Code Fax�7Z``�yQi
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E-Mail: / S�( �ll��l C1C L� D ,f�-ef Phone No 7Z �`7 �S�
Fill in fe simple Title Holder on next page ( if different E-Mail 1LL1'16'nn)L'C C��'YICQ<S ,�
from the Owner listed above) State or ounty License_-C
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.
Eft ;a, .'
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
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 attornev before commencine work or recording vour Notice of Commencement.
i
Si f Owrl�er Lessee/Contractor as Agent for Owner
n. o Cont ac or/License
Holder
�
STATE OF FLORID J ,
Lj
STATE OF FLORID.
COUNTY OFF �—
COUNTY OF Lc
Sworn to (or affirmed) and subscribed before me of
Sw�pto (or affirmed) and subscribed
before me of
Physical Presence or Online Notarization
Physical Presence or
Online Notarization
this day of KJ J V Q 2020 by
this day of
2020 by
Name of person irialkirig statement.
Name of person akingstatement.
Personally Known ✓ OR Produced Identification
Personally Known V/OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�J kn= •--
9i
/lam'
(Signature of Notary Publ'
(Signature of Notary Publi
�.p►• Notary Public Stale of Flaride
Crain A,Groaaman
�,�r� Notary Public State of Florida
Commission No. My� isawn GG 983060
Expire c OS/10/2024
ommission No.
Cro - rnl non GG
My emm on GG 98306fi
a Rd
,a R Expires 05110/2024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20