HomeMy WebLinkAbout3225 COLUMBRINA CIR (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
971� LE
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: 3225 COLUMBRINA CIR
PROPOSED IMPROVEMENT LOCATION:
Address: 3225 COLUMBRINA CIR PORT ST LUCIE FL 34952
Property Tax ID #: 3425-702-0031-000-5
Site Plan Name:
Project Name: JOAN TREWIN
DETAILED DESCRIPTION OF WORK:
AC CHANGE OUT-5 TON 14 SEER 10KW
Lot No.23
Block No. 10
New Electrical Meter Second Electrical Meter
FCONSTRUCTION INFORMATION:
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: $ fir. Utilities:
—Sewer —Septic Building Height: _
OWNER/LESSEE:
CONTRACTOR: l
NameJOAN TREWIN
Name: MICHAEL FORGIONE
Address: 3225 COLUMBRINA CIR
Company: UNIVERSAL AIR & HEAT
City: PORT ST LUCIE State:
Address:5460 W STATE RD 84 # 12
Zip Code: 34952 Fax:
City: DAVIE State: FL
Phone No. 772-201-5318
Zip Code: 33314 Fax: 954-318-0584
E-Mail:Trewjo@comcast.net
Phone No 954-581-7110
Fill in fee simple Title Holder on next page ( if different
E-Mail Permitting@Uahac.com
from the Owner listed above)
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 LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
Not Applicable
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:`
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone: -
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I I I
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 yo tend to obtain financing, consult
with lender or an att gfe c sing work or recoriice of Commencement.
Not Applicable
State:
Signature of
as Agent for
of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF F3-(-OW cC8 COUNTY OFBROWARo
Sworn to (or affirmed) and subscribed before me of
4 Physical Presence or Online Notarization
this _4 day of WNGrtJr, �^ by
tin. F � . _ - e '10 aJ
Nameof person mhing katement.
Not Applicable
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
this 15 day of MARCH )[]] by
MICHAEL FORGONE
Name of person making statement.
Personally Known OR Produced Identification Personally Known x
Type of Identification Type of Identification
Produced ►u Nara p 7uced
ry ut�he 5sats of Flog
Slade Pagura
• MY Commission GG 150367 V
(Signature of Notary Pu c- i (' nature of Notary Pu'
Commission No. ISO (Seal) Commission No. GG150367
REVIEWS FRONT ZONING
I I COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
OR Produced Identification
'L �,_Aary Public State of Florid.
--�lacie Fagura
�-
r My Commission GG 150367
Expires 02/02/2022
(Seal)
SUPERVISOR I PLANS I VEGETATION SEATURTLE MANGROVE
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