HomeMy WebLinkAboutKELLY RESIDENCE PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5124/21 Permit Number:
U `� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial I Residential xxx
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FORUKE FOR LIKE A/C CHANGEOUT
PROPOSED IMPROVEMENT LOCATION:
Address: 8609 TOMPSON POINT ROAD, PORT ST LUCIE FL 34986
Property Tax ID #: 3327-704-0023-000-1 Lot No.
Site Plan Name: Block No.
Project Name: KELLY RESIDENCE
DETAILED DESCRIPTION OF WORK:
LIKE FOR LIKE A/C CHANGEOUT - 16 SEER LENNOX 4 TON SPLIT SYSTEM - 9KW HEATER
New Electrical Meter Second Electrical Meter
CONSTRUCTION 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: $ 5980.00 Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
NameKEVIN & NANCY KELLY
Name:PHILIP VISA JR
Address:8609 TOMPSON POINT ROAD
Company: NISAIR AIR CONDITIONING
City: PORT ST LUCIE State: _
Address:3700 S, US HIGHWAY 1
Zip Code: 34986 Fax:
City: FORT PIERCE State: FL
Phone No.616-648-8982
Zip Code: 34982 Fax:
E-Mail:KRISTIN@NISAIR.COM
Phone N0772-466-8115
Fill in fee simple Title Holder on next page (if different
E-Mail KRISTIN@NISAIR.COM
from the Owner listed above)
i
State or County LicenseCAC041199
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
Name:
Address:
City: _ State•
Zip: Phone_
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone: _
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 IendeManAttorne�y before commencing work or record' our Notice of Commencement.
Signature of Owner/
STATE OF FLORIDA
COUNTY OF sT LUCIE
as Agent for Owner
Sworn to (or affirmed) and subscribed before me of
xx Physical Presence or Online Notarization
this 24TH day of MAY 2020 by
PHILIP NISA JR
Name of person making statement.
Perso ally Known xxx OR Produced Identification
Typepf Identificatiy'n)
signature of Notary Pub
y p• SKRS IN BAITSHOLTS
Flon
Commission No. GG278527 =_° �= tat of4ion #Notary Publi
— •� Co ion # GG 278527
My Commission Expires
February 19, 2023
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
re of Contra ctor/L rce rise Holder
STATE OF FLORIDA
COUNTY OF STLUCIE
Sworn to (or affirmed) and subscribed before me of
xx Physical Presence or Online Notarization
this 24TH day of MAY 2020 by
PHILIP NISA JR
Name of person making statement.
Personally Known xxx
Type otl Identification
OR Produced Identification
( ig ature of Notary Public-
tib(ori¢ ISTIN BAITSHOL
�n State of Florida -Notary Pu
S
li
Commission No. GG278527
" QQ�}jssion # GG 2785
y mmission Expire
February 19, 2023
7
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