HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ap V-a,_ dit y�
Date: 12-02-2021 Permit Number:`-"�602-032-r'
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4 -1a.-- s
RECEWED
DEC 0 2 2020
Building Permit Application Permitting Deparfiffent
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:install air conditioner
PROPOSED IMPROVEMENT LOCATION:
Address: 3105 s 23 street
Property Tax ID#: 2428-603-0021-000/4
Site Plan Name: EDGEWOOD ACRES
Project Name:
DETAILED DESCRIPTION OF WORK:,
INSTALL AIR CONDITIONER �0 LV
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
St. Lucie County
Residential 2002-0325
Lot No.3
Block No. 2
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE.:
CONTRACTOR:
NameASULINA SHIOMI
Name: RICK KULCZYNSKI
Company:A ALL MAJOR BRANDS CORP.
Address: P.O. BOX 6211
City: MIAMI BEACH State: _
Address:1901 RIO VISTA DRIVE
Zip Code: 33141 Fax:
City: FORT PIERCE State: FL
Phone No.786-309-0058
Zip Code: 34949 Fax:
E-Mail:
Phone No305-688-4406 CELL 305-389-7552
E-MailCACA33571 @,AOL.COM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County LicenseCACA33571
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
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 nt and posted on the jobsite before the first inspectio If yo intend to obtain financing, consult
wi a or an ne efore commencin work or recor ' o o 'ce of ommencement.
/� ZZ/�
ignature of O ner/ a/Contractor as Agent for Owner
Sigp9ture of Contr ctor/Lic Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5 =\v
COUNTY OF SAINT LUCIE
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online. Notarization
this a day of D e c- 2020 by
this _J%_ day of �) e, Z , 2020 by
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�'.cky�cz-� v..31e
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced k -
Produced p L
(Signature of Notary blic- State of Florida)
,Signature of Nota VENs ;
Commission No.�{y pa.a pa3 v1.�f�t�
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REVIEWS
FRONT
sod
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20