HomeMy WebLinkAboutPermit App for 5163 N Highway A1A Unit 120All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8-9-21 Permit Number:
0 IN .
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 5163 N HIGHWAY A1A 120 (-)n i4 /,.�20
Property Tax ID #: 1411-708-0004-000-6 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Like for like AC changeout 2 ton 14 seer 5 kw heat
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 2900.00
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ronald Ratz
Name: Shyan Wojtczak
Address: PO Box 10623
Company: Cool Air Solutions of Florida, Inc.
City: Green Bay, WI State: _
Zip Code: 54307 Fax:
Phone No. 772-713-6475
Address: 7901 Santana Ave
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-801-5398
Phone No 772-634-0491
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail coolairsol@gmail.com
State or County License CAC# 1819009
IT value oT Construction is LSUU 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:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: T 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-4df Owner/ Les Co tractor as Agent for Owner
Signature/of Contractor t-i ense Holder
STATE OF FLORIDA .
COUNTY OF (~._ ic,1 Ci"
STATE OF FLORIDA,
COUNTY OF S1 L_ LAC-1'
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
___. Physical Presence or Online Notarization
`" Physical Presence or Online Notarization
this `% `"day of it U(-(_A---i 2020 by
this `�day of AL;C;�_J f 12020 by
Name of erson making statement.
Name of person making statement.
Personally Known i� OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pr duced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. �. � �1V1) NotaobIC State of
ma.tdaP Sande
My Commission GG
F _(c? t1
t`1m1 ion N� �+ otary Publt�txe of Florida
on o + ^ Amanda P Sanderson
t t 258 c K nny C ,nnnissian GG 271256
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