HomeMy WebLinkAboutBuilding Permit Application All APPLICABC.s+.NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:12-02-2021 Permit Number--��
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DEC 0 2 2020
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Building Permit Application Permitting Department
Planning and Development Services St.Lucie county
Building and Code Regulation Division Commercial Residential 2002-0325
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:install air conditioner
'PR0POSD E#1/(PRa1/EMET,LOCA 'l Nr � k k]F U p S hL k3 4
Address: 3105 s 23 street
Property Tax ID#: 2428-603-0021-000/4 Lot No.3
Site Plan Name: EDGEWOOD ACRES Block No. 2
Project Name:
INSTALL AIR CONDITIONER ZV S'
I
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New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit—check all that apply:
I —Mechanical —Gas Tank Gas Piping- Shutters Windows/Doors Pond
Electric —Plumbing —Sprinklers Generator Roof Pitch
— —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
i
cost of Construction: $ .4 lwd,v Utilities: — —
Sewer -Septic Building Height:
NameASULINA SHIOMI Name:RICK KULCZYNSKI
Address:P.O. BOX 6211 Company:A ALL MAJOR BRANDS CORP.
City: State:MIAMI BEACH 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 N0305-688-4406 CELL 305-389-7552
Fill in fee simple Title Holder on next page(if different E-MailCACA33571 @AOL.COM
from the Owner listed above) State or County LicenseCACA33571
It 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.
F
ll APPUCAB�z'-INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
9 V.0
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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:
Address:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit—check all that apply:
Mechanical _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:
ON i -O 48
,
'ESS�3E', Y�-i=0
Name Name: Mr
Address: Company:
City: State:_ Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applica ble
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
improve�nt
is to our property. A Notice of Commencement b r orded in the public records of St.
Lucie uan os d on the jobsite before the first insp ion. I int n.d b in financing, consult
wi lendr n atl, r efore commencing work or re rdin r No ce mencement.
gn a t G-reof er Less rac tor as Ag nt for Owner nature of Cont actor/ ' ens Holder
STATE OF FLORIDA �p1� STATE OF FLORIDA c�
COUNTY OF � cisL COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
_Physical Preis ce or Online Notarization Physical Presen e or Online Notarization
this .3 day of - 2020 by this '3 day of 2020 by
Name of person making statemento 5 Name of person making statemen .
Personally Known OR Produced Identification Personally Known OR Produced Identification v
Type f Identification Type of Identification
Prod c d Prod d
&NkJL
Q�,,��gntur of Notary Public-5tkb of Florida) ( ' ture of Notary P bllet-St
Commission No. ot:�°�,: LASHP.Hi �} Q220'22
i7,SHFtH,NAIN�G�M-BANNING
Commission No. �•
;; L. * MY COMMISSION = itiY CCiv..... W#GG 275D60
EXPIRES:Dec "9,Fo�FLo° EXPIRES:December 20,2022
Bonded Thru Notary is n erwritersREVIEWS F 1aWI IfPLANS VEGETATION SEATURTLE MANGR
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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