HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/14/20
Permit Number:
971
o ,
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:AC CHANGE OUT
PROPOSED IMPROVEMENT LOCATION:
Address: 877 NETTLES BLVD-
Property Tax ID #: 4502 501 1063 000 7
Site Plan Name:
Project Name: ANDREW VANDERKLOK
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
AC CHANGE OUT- RHEEM-RA1 648AJ1 NA RHEEM-RH1T4821STANJA L�,`� _ Q)c L.
4 TON 16 SEER 10 KW
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical — Gas Tank —Gas Piping _ Shutters _ Windows/Doors Pond
_ Electric — Plumbing i Sprinklers ^ Generator — Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 5030.28
OWNER/LESSEE:
Name ANDREW VANDERKLOK
Address:6635 W 64 ST
City: FREEMONT State:
Zip Code: 49412 Fax:
Phone No.616-560-1879
E-Mail:
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:MICHAEL FORGIONE _
Company: UNIVERSAL AIR AND HEAT
Address:5460 ST RD 84 # 12 _ -
City: DAVIE State.I L
Zip Code: 33314 Fax: 954-318-0584
Phone No954-581-7110
E-Mail PERMITTING@UAHAC.COM
State or County License CAC058142
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 LAIN INFORMATION:
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 attorngy before commencing work or recording our Notice of mmencement.
JOK
//�X
Signature of O er L see/C Vctor as Agent for Owner
Signature of C t or/L' rise H Ider
STATE OF FLORIDAO
STATE OF FLORI A
COUNTY OF
COUNTY 0FBROWARD
worn to (or affirmed) and subscribed before me of
Sworn to for affirmed) and subscribed before me of
Physical Presence or Online Notarization
x Physical Presence or Online Notarization
t is day of 2020 by
this 14 day of DEC , 2020 by
MICHAEL FORGIONE
Name of person making statement.
Name of person making statement.
Personally Known OR Produced identification
Personally Known x OR Produced Identification
Type of identification
Type of Identification
Produced
(Signature of Notary Public- tate of Florida)
of Notary Publi -
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