HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3/1/2021 Permit Number:
Z ''L CLL_
t` L 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:Aif Conditioning Changeout
PROPOSED IMPROVEMENT LOCATION:
Address: 10109 Crosby PI
Property Tax ID#: 3327-710-0013-000-7 Lot No. 111
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
rT
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Ad�diittional work to be performed under this permit—check all that apply:
7�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: $ 4,500 Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Ronald M Darling Jr Name:Lee Baker
Address:401 E 60th St. Apt 37C Company:A/C Enforcement, Inc.
City: New York State: Address: 1849 SW Altman Avenue
Zip Code: 10022 Fax:_ City: PSL State:FL
Phone No.646-761-2432 Zip Code: 34953 Fax:
E-Mail: Phone No 772-359-4504
Fill in fee simple Title Holder on next page(if different E-Mail Lee@makoconstruction.com
from the Owner listed above) State or County License CAC1818170
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 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 a before commencing work or recording our Nqtice mmencement.
i
Signature of Owner/Lessee/Contractor as Agent for Owner Signature Contractor/License Holder
STATE OF FLORIDA I I STATE OF FLORIDA .
COUNTY OF COUNTY OF 5_� LA-4(-e
Kw9fin to(or affirmed)and subscribed before me of n to(or affirmed)and subscribed before me of
Pysical Presence or Online Notarization Ph sical Presence or Online Notarization
this day of n4k� T , 2021 by this day of 2020 by
Name of person making sZOR
atement. Name of person making statement.
Personally Known Produced Identification Personally Known � OR Produced Identification
Type of Identification Type of Identification
Produced Pro du ed
(silgrikure o Notary Pub i St�oo. FlW�d* ublicStateofFoWda (Signature of Notary Public
Katherine Lecomte �. P4� Notary Public State of Florida
Commission No. M AAq�%ssion GG 120165 - ppi�ggg�q�
aFo� E> rb§t16129l2021 ommission No. My`t;erifmisseio ion 120165
•;P�eG/pot Expires 06/29/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20