HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5/3/2021
Permit Number:
S17. L UP C!DE'
A Building pp 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:
Address: 5012 PALM DR
Property Tax ID #: 3402-608-0174-000-9
Site Plan Name:
Project Name:
LIKE FOR LIKE 3 TON 16.5 SEER SYSTEM WITH 7.5 KW HEATER
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
Lot No.
Block No.
1--Vechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 4760.00
Name KRYSTAL WILLIAMS
Address: 5012 PALM DR
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
City: FORT PIERCE State: 1 ( -
Zip Code: 34982 Fax:
Phone No. 772-216-8005
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: CURTIS SAMMONS
Company: CUSTOM AIR SYSTEMS INC
Address: 1615 SE VILLAGE GREEN DR
City: PORT SAINT LUCIE State: FL
Zip Code: 34952 Fax: 772-335-1968
Phone No 772-335-3232
E-Mail CUSTAIRSYS@AOL.COM
State or County License CAC051810
IT value of construction is Z500 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.
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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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF 5 T L_ u c t
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this � day of 202P by
hysical Presence or Online Notarization
this day of 2020 by
C'u���s s�,nmans
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known is OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced T]'
'��irLLGl�
c.E
(Signature of Notary Public- State of Florida)
(Signature of Notdry Pub' - State of 'l Fla) CHRISTINE B. ENGLI
Commission No. (Seal)
Commission No.#11 b6 fU 7 * a6=1w#HH0693
B~ ThN Bwdgd No ,,i Setv
7
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
CUSTOM AIR SYSTEMS INC. SALES * SERVICE * INSTALLATION * APPLIANCES
1615 SE. VILLAGE GREEN DR. PORT ST. LUCIE FL.34952
335-3232 465-0559 562-2777 FAX (772)335-1968
CAC051810
LENNOX * CARRIER * RUUD * GOODMAN * TRANE * AIR CONDITIONERS
April 30, 2021
NAME: KRYSTAL WILLIAMS
PHONE: 772-216-8005
EMAIL: krystaldawnl0@gmail.com
ADDRESS:
HAS 3 TON SYSTEM WITH 7.5 KW HEAT STRIP. AIR HANDLER IN THE CLOSET
WE PROPOSE TO: REPLACE EXISTING AIR AND HEATING SYSTEM.
BID INCLUDES THE FOLLOWING.
1. 3 TON STRAIGHT COOL SYSTEM (SEE OPTIONS BELOW)
2. CONNECT TO EXISTING REFRIGERANT LINES
3. CONNECT TO EXISTING HIGH AND LOW VOLTAGE WIRING. (BREAKERS AS NEEDED)
4. DIGITAL THERMOSTAT
5. PERMIT (INSPECTION BY BUILDING DEPARTMENT REQUIRED)
6. CONNECT TO EXISTING DUCT SYSTEM
7. DRAIN LINE SAFETY FLOAT SWITCH & NEW CONDENSATE PUMP
8. NEW AUXILIARY PAN
9. CONDENSER TIE DOWN BRACKETS
10. ONE YEAR LABOR WARRANTY
11. FIVE YEAR CHAMPION. (TEN YEAR PART WARRANTY TO ORIGINAL OWNER IF REGISTERED WITHIN 30 DAYS
OF INSTALLATION.)
CHAMPION 3 TON 16.5 SEER STRAIGHT COOL SYSTEM. 7.5 KW BACKUP STRIP
TC7B3621S, AE36CX21-TXV
FOR THE SUM OF: $ 4,760.00 (FPL REBATE - 150.00) $ 4,610.00 INITIAL
IF PAID BY CHECK: 4,380.00
CHAMPION 10 YEAR LABOR AGREEMENT FOR THE SUM OF: $ 350.00 PLUS TAX INITIAL
QUOTE GOOD FOR 30 DAYS
TO BE PAID: AT TIME OF SERVICE.
ACCEPTED ........................... SIGNED... ....... ............ I-
RONNIE LAUCH
CUSTOM AIR SYSTEMS INC.
Construction industries recovery fund: Payment may be available from the construction industries recovery fund if you lose money on a project performed
under contract, where the loss results from specified violations of Florida law by a state -licensed contractor, for information about the recovery fund and filing
a claim, contact the Florida construction industry licensing board.
Phone: 850-487-1395 mailing address: DBPR customer contact, 1940 N. Monroe st., "fallahassee, FL. 32399-0786