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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1s\7'1 Permit Number: S `t- Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: n JJ.._--. "l L.A4 O V':C" Trn . I * Property Tax ID#: �H�a 5U�.�Ll-4 Lot No. Site Plan Name: Block No. Project Name: F—bf( 16-nr'a Un-,'11 Zy') kc I DETAILED DESCRIPTION OF WORK: 0 New Electrical Meter Second Electrical CONSTRUCTION INFORMATION: Additional work to be performed under this permit- check all that apply: (Affidavit required) H ✓Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Cost of Construction: $ 3dLoo, L' Sq. Ft. of First Floor: Utilities: —Sewer _Septic Building Height: OWNER/LESSEE: _ CONTRACTOR: Name Ll' -y'e� Gyv,-F,( Name: C /a Address: 1;-M Cn-ez--%Qo,A Company:my2 Eratt�r;S�a DMA Fi City: N"f-bJti'�' State:l5 Zip Code: qN his Fax: Phone No. Addregs:(421) 1IC inn as City: 1 `'ik S�' ULYL� Q State: Zip Code: 41 ? Fax"Na-4(*)/)(v3) Phone No ``II0)-1313 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail�tQ4N✓uC�r� •i ervt State or County License C.tJ CoS6 3-3-' 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. b{t!}:t`rn:t• �".a''•:w aS�YYif .. �' p 'i'_ .i q' d r jNUPPLEN'IEN=C n E ``'I,�. I 0 ,._ ,. . .S. 5 v'{. t� �v rx'��%rYs ., e, f .r tiS is t;SSv��� S F � e�.. 3!( Yt }�.s iP ,}, _ ,. .77'=d!'.•,4 i. �iv.../..S�.E...fi�..d"c. ����1..•i.,..f.:F:R.-r.'7:.ifd: .fit t xel+�hy� c ,i; 4 r• ..'i°„i,.i: .rrl�l DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: 1 ' Name: Address: 6 d Address: City: State?' ` City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: 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 off 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 1314ilding 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'r 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 r. STATE OF FLORIDA 5� COUNTY OF LU Lit (_©ov Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization this\LAy- day of 20� by Name of person making statement. Personally Known OR Produced Identification T f Identification Produced t. nature of Notary Public- State of Florida) � f Commission No." t'►L `10k 0b4 (Seal) JESSICA GROVER otary Public -State of Florid �= Commission # HH 119064 .� My Commission Expires #III%%``` April 19, 2025 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev 5/2072T— LlRmse Numbe$ Fort Pierce Service Center CA`:00 6811 Heritage Dr • Port Saint Lucie, FL 34952 • Phone: (888) 237-7070 CFLORVISr CFC032576 ESOO0033a EQUIPMENT PROPOSAL OPTION 1 OPTION 2 MANUFACTURER: AH MODEL CU MODEL MOTOR COOLING STAGES SEER I� TONS HEATER SUBTOTAL. U OTHER DISCOUNTS: _ c SU TOTAL INVESTMENT: Installation shall include: ❑ New reinforced equipment pad ❑ CIU Breaker Brand _ Size _ ❑ Reconnect to existing lines ❑ AIH Breaker Brand Size _ ❑ Permit included ❑ Hurricane Brackets or Strapping ❑ Install new thermostat ❑ Corrugated pipe _ ft. ❑ Install new H-slat ❑ Meet all code requirements ❑ Vertical ❑ Horizontal ❑ Complete system start up ❑ Filter Rack ❑ Stand ❑ _ year parts MFG warranty ❑ 2nd Pan ❑ Vert ❑ Horz ❑ _ year labor BFS warranty ❑ Hanging ❑ Attic ❑ Shelf ❑ _ year maintenance ❑ UV paint ❑ Crane service Additional work to be Performed Installation does not include any duct work or line set unless spencilied on proposal. Drain cleaning or old line sets are not guaranteed, Maintenance must be performed at least once a year to system to honor part and labor warranty. Customer responsible for any condo association approvals on changes to HVAC systems. Method of Payment Accepted: O Check O Visa O Master Card O American Express O Cash O Financing O Deposit _ Card number Exp. date Security Code Authorized Signature Note: This proposal may be withdrawn by us if not accepted within 30 days Billing Address Payment in full Is due upon startup -All malarial a guaranteed tow as$peufed. Mworkistobecom*b mawakmanaemarmeracmmagloslanoa,dpadues SFSwln not be responaee for property damagevaum removdg of mpa, 'J6tnra mnddionmg rydam Including but not brides to Who accesl amnrases. noon mm. well etc. Any allemban or derruin. from above speofiuuam imcwhrg a ara mds wrl be erecuted only upenvadi Omer$, and wig WWM en emm ch; are, and above the esumala All agmements cdnlingent upon strikesaccr ents or delays beyond our control. Owner to carry full. and other necessary Insurance Our wader are May =verso by Wodmens Campani Inaurance Acceptance of Proposal - The above prices. specifications and conditions are satisfactory and are hereby Signature accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature All sales are final with no adjustments or refunds. 10yr MFG Pans Warranty if registered by customer only applies to original purchaser