HomeMy WebLinkAboutel sito cout form.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6-11 -21
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Permit Number:
rTTTT-['-E zi ~-''.~- Building permit Application
Planning and Development Services
Building and code Regulation Division Commerc.lal
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
Address: 160 SE EI Sito Ct
Property Tax ID #:
Site Plan Name:
Project Name:
3419-540-0323-000/4 Lot No. 8
Block No. 53
DETAILED DESCRIPTION OF WORK:
Like for Like HVAC chan
2ton 14 seer Pa ne air condionin
5KW heat stri
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
A Mechanical Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing _ Sprinklers Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: S
Sq. Ft. of First Floor:
Utilities: Sewer _ Septic Building Height:
OWNER/LESSEE:CONTRACTOR:
Name ame:Py-A MenhflinifcL( Air r]rvirj i``t+`r\m,-#q
Address:ompany: Mic,haed tlthne ' v
City: State :Address: rBiD S.[`? flrqcur#can+ 5;+
city:Tdrs+ LmATQ State:HZip code: Fax:
Phone No.Zip code: SLjcl#5 Fax:
E-Mail:PhoneNo+1?:3r]ury`'1t`Qur.i
Fill in fee simple Title Holder on next page ( if different E-MaH Sl-qh¢`+uVTe, Cur, .quc€iF #TU?/9'Cm4{'cL{.#a n@ +
State or c;unty License r4dy?_Htofrom the Owner listed above)
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.
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DESIGNER/ENGINEER: jsL Not Applicable MORTGAGE COMPANY: J£ Not Applicable
Name:Name:
Address:Address:
City: State:City: State:
Zip: Phone Zip: Phone:
FEESIMPLETITLE HOLDER: j| NotApplicableName:B0NDING COMPANY: j[Not Applicable
Name:
Address:Address:
Cit:Cit:
Zip: Phone:Zip, Phone:
OWNER/ CON TRACTOR AF FIDVIT: 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.
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ln consideration of the granting of this requested permit,I do hereby agree that I will, in all respects, perform the work
in accordance wit h the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following bui ding permit app ications are exempt from undergoing a full c oncurrency 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 resu t in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the publi c records of St.
Lucie County and posted on the jobsi te before the f irst inspec tion. If you intend to obtain fin ancing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
?-.`.ul`.i:J.vi\.'L .: :JJ -ji- -..`' ,`.;'=: :` `
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID?,\+ , Ltry`t4COUNTYOF sTATEOFFLOR[DA/\+ \ul,,`,a,COUNTYOF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
|L physical presence or online Notari zation X` physi Gal presence or Online Notari zation
thisjJ=day of TTA,tQ, 202j¢p,by J}4±this|jj[iday of Liz;ir`e ' 202?g`\bYL¢a,,i
f\\\r\'\ p\ lJCL+r\f>\\\\rhr^r,,( `\, lrLLHto
Name of per5o-n making Statement,Naine of person making statement.
Personally Known i OR produced Identification PersonaHy Known i OR produced Identification
Type of Identification Type of lde ntification
Produced Pro;lie,:H,,v„L uu`,,` ±~,FTt,, tr\u,rf ft,
` `^,;beL!rd.vutL kRE(1 vu{7l;\/
Commission No.I 1 .7 / ,, { q
97659z§om ssio
nNo. Ilr7hF3C;I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU RTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLETED
ev.51612J)