HomeMy WebLinkAboutSt. Lucie Realty Grp - 899 Prima Vista - Ninja Thai 5 ton AC changeout permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
�-
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:q-] Q�p 10"�-r�,,��
11�iT LOCATION. ---
Address: 1� 1 1-1 >, LY%I iu V 1 S�o / t/d
f
Property Tax ID#: 3 ` 1 q'5t5--000 /"p/ y--&-v Lot No,
Site Plan Name: Q1 1, ,,,,,
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping -Shutters _ Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1--5 1'-3Utilities: _ Sewer _ Septic Building Height:
Name - G' e- U-4-
Address: 1'1tMQ Sk 5;� P
City: 16y_ , W Crt State: R,
Zip Code: S _ Fax.--77Z 3?9-q%?-'1
Phone No. 1-7 Z-R,!g •- Q`?Z'j
E-MaiI:C lr�S 1)QCA5D(-)0Y rYVV, .
Fill in fdd simple Title Holder on next page ( if different
from the Owner listed above)
Name: • fry {SUSS
Company r) 14 `y-
Addre s: ( �+ sy
City: D ('�� Stater
ZipCode:� Fax777��3q
Phone No - 7 7- 3 9 _ 2A' -
E-Mail DSS C Yi ee
State or County License
I I W1 d M %-Ur%„c„ rvuuce er commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
:e�3'e5�`Cazx� �' • u1 � 5
t`1RCa..u.
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 your Notice of Commencement.
Lessee/Contractor as Agent for Owner Whi
STATE OF FLORIDA (( STATE OF FLORID&4
COUNTY OF I.i�LGCOUNTY OF
Swornlo (or affirmed) and subscribed before me of
V Physical Pretise_nce or Online Notarization
this' i7. day of 202,11 by
�� t�-s�r� ►1 1 � �, �n c�Yvl � �
Name of person1making �Catement.
Personally Known �// OR Produced Identification
Type of Identification
tense H
Sworpto (or affirmed) and subscribed before me of
V Ph site cal Prence r Online Notarization
thiss day of 2021 by
S
Name of person aking tatement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pubi
(Signature of Notary Publi
�.✓�ii� Notary Public State of Flails
Cr A Osaman
r�,!Pr
Notary Public State of Floods
Commission No.
My t,etonGG9830ff6
ommission No.
Mra(� tssman
y ommt ,ton GG 983069
C
o, nd Exones 05n012024
'yia R Espires 05,10,2024
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