HomeMy WebLinkAboutPermit Application .pdfAll APPUCABLE INFO RAU57 BE COWWLETED FOR APPUCAT0ON TO BE ACCEPTED
Date: 6/14/2021
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Permiumber:
Building Permgt, A'ppDoca:oo�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Ford Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
PERMUT APPLICATION FOR. MechanIs�caG
PROPOSED IMPROVEMENT LOCATION:
Address: 7857 Meadowlark Lane
Property Tax I D #: 3425-706-0205,-000-8
Site Plan Name:
Project Name; Pozun-Residence
DETAILED DESCRIPTION OF WORK:
Like for Like Package Unit Replacement
3 ton-14 Seer-8 kw- Ground
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
Electric
Plumbing
Sprinklers
Generator
Residential XXX
Lot No.
Block No.
Windows/Doors Pond
Roof Pitch
bw-*W-ffiqw�
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 5500,00 Utilities: _Sewer � Septic Building Height-,
OWNER/LESSEE: CONTRACTOR:
NameEdward Pozu - n Name:Don Miranda
Address:7857 Meaowlark Lane Company: Miranda Plumbing & Air Conditioning
City: Port St Lucie State: Address: 750 NW Enterprise Drive
Zip Code: 34952 Fax: city:.Port St Lucie State: FL
Phone NO, 814-533-9498 Zip Code: 34986 Fax:
E-Mail: EFPOZUN@GMAIL.COM Phone N0772'$78-5123
Fill in fee sompBe Title Holder an next page if different E-Mail Ldiodato@mirandacompanies.com
from the (Owner Hsted alaaveD State or County License CAC1815486
If
value
of
constructionis
2.500 or moire, a RECORDED Notice of Commencement is required.
If
value
of
HAVC'O's $7,500
or more, a RECORDED Notice of Commencement is required.
M e signed by ownerlAgent and appHcante
N6
(Signature of contractor)
State of Florida, County of --S)L 4f, c.•� C ,
ed to and subscribed before me this
P20 2t. 7 by L*� -tJ Iv
ally known to me or who has produced
tification.
Signature
..'%.- -
(print name)
MENCEATE-N, T.
J
r
�..,r
{Signature of Owner or Agent {including contractor}}
State of Florida, County of
Affirmed to and subscribed before me this
20 -5 by -v -xvlt oz-t,,- v) el -4�.
personally known to me or who has produced
as identification.
Notary Signature
x
�otary 1 1 ,� �. J
N �; ��%ns uction documents must accompany this application. The Florida energy code submitted beco � '�Y A, % - - 4, toe g1 a �� TO
R e of Florida
d must pass final inspection. "Notice: In addition to the requirements of this permit, there n �
applicable to this properly that may be found in the public record of this county, and there may be a d ��'�pet%-fi9gnyb fgqdmar 3. 2025
from other governmental entities such as waste management district, state agencies, or federal age n ' ry Assn.
APPLICANT MUST BE NOTARIZED. If owner builder, applicant must sign in person. BUILDING PERMIT includes:
Building, Electrical, Plumbing, Mechanical, and Sewer only. All other trades require separate applications.
Asbestos compliance: It is the owner's or operator's responsibility to comply with section 469.003, Florida Statutes, and
to notify the Department of Environmental Protection of his or her intentions to remove asbestos, when applicable, in
accordance with state and federal law,
FEE SIMPLE TITLEHO]LdD1ER, BONDING COMPANY AND MORTGAGE LENDER INFORMATION IS REQUIREID WHEN
THE AGGREGATE Vf41LB1E (TOTAL COST OF ALL IMPROVEMENTS AND NOT JUST WORK AUTHORIZED BY THE
INDIVIDUAL PERMI"V) IS $2500 OR MORE (EXCEPT HVAC R]EPAIR/18EP]LACEMEI9'T< $7500). PLEASE ADDRESS ALL
ITEMS.
Fee Simple Titleholder's D Same as Owner
Name (if other than owner):
Address:
City• State: ZiP:
Bonding Company ❑ Not Applicable
Name:
Address:
City Zip:
Mortgage Lender's [3 Not Applicable
Name:
Address:
CRY: State: Zip:
OFFICE USE ONLY
Is the property located in a Special Flood Hazard Area (floodplain) per the current Flood Insurance Rate Map {FIRM}
Flood Zone:
Permit Fee
State Surcharge
0
Subcontractor $
NIPPON i�iiipiirl
q RMWIP1111mi� =%
Remarks
Reviewed by'.
❑ Yes ❑ No
Deten-nination,
Other
Other
Flood Review Fee
M
w�
$ Plan Review Fee
$ Routing Fee
Other $
Active Code Violation El Yes ❑ No
Case #
Case Type
Reviewed by
Dale Final Check
Date
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