HomeMy WebLinkAboutMech APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5.27.2021 Permit Number:
L' L c L` —- Building 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:AC Change out
PROPOSED IMPROVEMENT LOCATION:
Address: 411 Willow Ave, Port St Lucie FL 34952
Property Tax ID #: 3419-510-0182-000-0
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
installation of 3.5 ton single stage 16 SEER split Ac system
New Electrical Meter
Second Electrical Meter
Lot No.17
Block No. 16
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 18084
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Diane Kirkland
Name: Leonard Cipolla
Address:411 Willow Ave
Company: Southern Coast Services
City: Port St Lucie State: _
Zip Code: 34952 Fax:
Phone No.(772) 361-5524
Address:1804 NW Madrdi Way
City: Boca Raton State: FL
Zip Code: 33432 Fax:
Phone No561-584-8455
E-Mail: kirkland911@att.net
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Permits@southerncoastservices.com
State or County License CAC1 819865
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
EER: _ Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:_
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:_
Zip:
Phone:
_Not Applicable
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
*h ie,,A,- r �, r.,m Angina„ Arlr-n e-r)rrlina vnur Nnti.r-.P of Corpraencement.
Signature of Owner Lessee/Contractor as Agent for Owner
"Signature of Contractor/License Holder
STATE OF FLORIDA-,a��G /
COUNTY OF )/ nG�
STATE OF FLO_ r .��/
COUNTY OF lA t1 F�
Sw r� to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
/Physical Presence or Online Notarization
this 2_day of "t, -L 2&2B by
_✓Physical Pre ence or Online Notarization
this day of i� ILZ �y
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Name of person making statement.
Name of person making statement.
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Personally Known Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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