HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8-12-21 Permit Number:
5 L o Q TTI--=-
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: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 5105 Deer Run Dr, Fort Pierce, FL 34951
Property Tax I D #: 1313-502-0019-000-1
Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Like for like AC changeout 5 ton 14 seer 10 kw heat
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 _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 6,800.00 Utilities: —Sewer _ Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name Leatha Mullins
Name: Shyan Wojtczak
Address: 5105 Deer Run Dr
Company: Cool Air Solutions of Florida, Inc.
City: Fort Pierce, FL State:
Address: 7901 Santana Ave
_
Zip Code: 34951 Fax:
City: Fort Pierce State: FL
Phone No. 772- 528-4617
Zip Code: 34951 Fax: 772-801-5398
E-Mail: mullinsl333@gmail.com
Phone No 772-634-0491
Fill in fee simple Title Holder on next page ( if different
E-Mail coolairsol@gmail.com
from the Owner listed above)
State or County License CAC# 1819009
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: I
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: T Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to cio the worK ana installation as 111UK dICU.
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
:, L_ _A r . ++., Y, ," k-f^rn .-nmmr3nrina %Ainrlt nr r?rnrriinrr vntJr Notice of Commencement.
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Signature f Owner/ Le's*e/Ccirltractor as Agent for Owner
Signature f Contractoryaeolder
STATE OF FLORIDA•
COUNTY OF J k L -C' tE
STATE OF FLORIDA
COUNTY OF L �..0 i G-
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 13t`'day of lit i� -1" , 2020 by
this t j day of I-� n�C=y-t 2020 by
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Name o person makingstatement.
Name of erson makiinggsstatement.
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Personally Known VgsOR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pr duced
Pr uced
(Signature of NotarryfPPublic- State of Florida j
(Signature of Notary Public- State of Florida )
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Rev. 5/b/ZU