HomeMy WebLinkAboutBuilding PermitAll APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T1 Z� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 ,�//
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:HVAC Equipment ChangeOut
Address:
Property Tax ID #:
Site Plan Name:
Project Name: —
Like for like AC replacement /
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Additional work to be performed under this permit— check all that apply:
Lklechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: I �za Sq. Ft. of First Floor:
Cost of Construction: $ �'/ Utilities: _Sewer _Septic
Name
Address: �ODZ
City: / / �1��� State: �L
Zip Code: 7��/ Fax:
Phone No. %Tz— 2/,5'-- J:XJ
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No. /��
Block No. /.T65�
Windows/Doors
Roof Pitch
Building Height:
Name:Steve Smith
Company: Steve Smith Air Conditioning
Address:8001 Eden Road
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-461-2036
Phone No772-461-1425
E-Mail stevesmithac@aol.com
State or County License CAC1 813454
if value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
Y� r .aOff;
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON T E JOB XM BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOU11CLENDEWAR AN ATTORNEY BEFORE RECORDING YOUR NOT10E,.0F COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORID
�'LUC. £'
COUNTY OF S-� I_U C.N F
COUNTY OF
The forgoing instrument was acknowledged before me
The for�ing instrument was acknowledged before me
/LI 20, � by
this L`Iday of tj, %A 20JA by
this ,"C day of
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification _ C
Personally Known OR Produced Identification k
Type of Identification
l7 Lk L I C_ E"' S EVtig- L I � E"' s E
Type of Identification
Produced r'l- L) t—
Produced Vtig-
�L
ignat a of ota Public- S to of Florid ChristopherJ.
NOTARY PLI
Stephanie Mour
LIC NOTARY PUBLI
rXN nature Notary Public- State o F*/QM6�
Commission No. zvL15-6 STATEOF
OSIPAission No. PF9Y 72e / STATE OF FLO
i
Coma GG
2758 Comm# FF9573
1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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