HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/7/2021 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Add,,,,,- 7909 BLACK TERN DR
Property Tax ID #: 3424-701-0023-000-0
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
LIKE FOR LIKE 4 TON 14 SEER PACKAGE UNIT 10 KW HEATER
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential X
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: Sq. Ft. of First Floor: _
Cost of Construction: $ 4815.00 Utilities: —Sewer _ Septii
Lot No._
Block No.
Windows/Doors _ Pond
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name AMY HANSEN
Name: CURTIS SAMMONS
Address: 7909 BLACK TERN DR
Company: CUSTOM AIR SYSTEMS INC
City: PORT SAINT LUCIE State: ��
Zip Code: 34952 Fax:
Phone No. 772-878-6083
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:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail CUSTAIRSYS@AOL.COM
State or County License CAC051810
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 Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 your 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 S't L, V C t £ COUNTY OF u ° ° it � t- 11 -e
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
y' Physical Presence Gr Online Notarization ✓Physical Presence or Online Notarization
this day of (LO 2024 by this day of _'S' 202$ by
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Name o
Name of person making statement. f person making statement_
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of N6tary Publ;~< State of Florida )
(/ 'Ay P& CHRISTINE B. ENGLIS
Commission No_ �f�rJb Q.�� #al}Cortunissior,HH0693
W411Expires April 4, 2025
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Nota-.1 Pub ' - State of FWD a ) CWJSTINE B. ENGLI£
Commission No..MAI 7 * L aI��HHom
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