HomeMy WebLinkAboutPERMIT APPLICATION - 5505 PALMETTO DRIVE - 07-21-2021All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
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PROPOSED IMPROVEMENT LOCATION:
Address: vlatmettoe
Property Tax ID #: 3-T 04— fco Coo8 ^ uoo—� Lot No.
Site Plan Name: Block No.
Project Name:INC QY)anxOo
DETAILED DESCRIPTION OF WORK:
eve cxis .5 as
-all nev) CAP-
- air Conrii-boniz.5 --
6 SOCR UIM B KW elegy
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
'nal work to be performed under this permit - check all that apply:
Ad7mechanical
_ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing u Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (�. 5 z� Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
I
Name:, f lr'(AUo Nry)I_
Name Oyes
Address:rJ aline we_
Company:
City: l State: �.
_
Address:jqm� �I r
Zip Code: f.� Fax:
City: State:
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Phone No.331_ 2.40_yL rjr)
Zip Code: 3 Fax:
E-Mail:
Phone No �� Stpp
Fill in fee simple Title Holder on next page ( if different
E-Mail OQr 'rC►re
State or County License C
from 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
oe
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
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 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 our Notice of Commencement.
Signature of Owner/ Le ractor a' gent for Owner
STATE OF FLORIDA pp
wC�l-Q.'
COUNTY OF el,
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of _L& q 2CL8� by F/Lt o`ytd.� l�p '" i
Name of person making statement. /
✓/
Personally Known OR Produced �dQntification
Type of Identification Produced ((��
(Signatur of Notary Public- State of F on )
CLAUDETTE D. PAYEN
Commission No. (Seal)NOTARY PUBLIC
STATE OF FLORIDA
*FISI"
Comm# GG298272
11
Expires 2/4/2023
REVIEWS
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SUPERVISOR
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED