HomeMy WebLinkAboutCassell Richard AC changeout permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 a(�sl I Permit Number:
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Building
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: ?, I L
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Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
J
Lot N o. -!
Block No.
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,
Cost of Construction: $ LO GO
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name 14 k C MrCC'\
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Name
Address: _.
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Zip Code: �S(-IM Fax:-TIQ
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Fill in fee simple Title Holder on next page (if different
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from the Owner listed above)
State
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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 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 ooiain a permmi w uu LIC WO N 0"u- ---
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
structure. Pleaslecconisult withpyoiur applicable
lome Owners Association and rules,
ev ew your deed for any restrictions which may aprohibit such
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
k c ordin our Notice of Commencement.
with lender oranlattorney before commencin wor
or re
Si f Ow rr Lessee/Contractor as Agent for Owner
; na ,fie 'Cont ac or/License Holder
`
STATE OF FLWIDA
STATE OF FLORIDA
S� L1ICa
COUNTY OF \ �_
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Swoyn to (or affirmed) and subscribed before me of
V Physical Pres nce or Online Notarization
his �/ Physical Presence r Online Notarization
`� day of 206?1 by
this day of 2C�1 by
t
Y� C foss Cln
Y u V C�ro�S IYl
Name of person aking statement.
ame of person aking statement.
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
q�
(Signature of Notary Publi
(Signature of Notary Publi
Notary Pubb; State of Flonds
0V Notary Public State of FlOrrda
Commission No. l A , o, GG 30e9
16 Cra ossman
ommission No. My r i�miiaron GG 983069
and EKp,resO5rt0/2024
,an E.piZs05r10i2024
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DATE
RECEIVED
DATE
COMPLETED
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