HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABBL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 (o I -L- Permit Number:
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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
PERMITAPPLICATION FOR: i
PROPOSED IMPROVEMEN
Address: 6unio^
PropertyTaxlDft: Lot No.
lr
Site Plan Name: Block No.
Project Name: F017-e lil % (Ler1 AA vnt_e-
DETAILED DESCRIPTION OF WORK
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GYM V�•n�t c� v� . �- s hv� �� 5�
New Electrical Meter Second Electrd al1tteter (Affidavit required)
CONSTRUCTION INFORMATION " r
Additional work to be performed under this p( i mit -check all that apply:
Mechanical _Gas Tank _Ga>Piping _Shutters —Windows/Doors _Pond
_ Electric _ Plumbing _ Spri lklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: _ Sq, Ft. of First Floor:
Cost of Construction: $ 5S92. Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE;
Name�(er��%fhP� F1o:�11� NameL�\ td, e.✓
Address: S -+D Company: (j4S
City: p-r )r Sh t.v4 f- State: tom- Address:
Zip Code: ?i 4jr b Fax: - City: �� S l U c State:_
Phone No. 397 Zip Code: Fax: %},)a'NbT- LJ3 )
E-Mail: Phone No_
Fill in fee simple Title Holder on next page (if c ifferent E-Mails
from the Owner listed above) State or County License- ClA C-O S(a
-I
If value of construction is 2500 or more, a RECORDE :.Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED No : e of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State;
City: State: _
Zip: Phone
i'
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Appjicable
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
is in Home Owners bylaws that may restrict or such
which conflict with any applicable -.Association rules, or and covenants prohibit
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 pernit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida BL'�ilding 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. I
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consul: i
with lender or an attorney before commencing work or recording our Notice of Commencement.
Sig�of Owner/ Lessee/Contractor as Agent for-Ofter
STATE OF FLORIDA
COUNTY OF Si— WC,
I
Sworn to (or affirmgd) and subscribed before me of, . -Physical Presence or _ Online Notarization
this lMday of fY,Cn)y)— 20Z by ..
4
-�IName of person making statement. ,
Personally Known —OR Produced Identificat on
_ell i(
-T f Identification Produced I' i
' nature of Notary Public -State of Florida) I
t� n
Commission No.Tt�A II90ey (Seal) - GROVER
Public•State o} Florida
f Flo64
Commissionk He
FEQ1NN%NotaryJESSICA
My Commission Expires
April 19, 2025
REVIEWS
FRONT
ZONING
SL:PERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
;2EVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
License Numbers:
Voku,
CAC05Fort Pierce Service Center CAC0567747406811 Heritage Dr • Port Saint Lucie, FL 34952 • Phone: (888) 237-7070 CFCOffi576
ES0000336
EQUIPMENT PROPOSAL
PROPOSAL SUBMITTED TO 0 1 CONTRACT # �,TD1035 06 SALESPERSON DATE �Z
STREET CITY, STATE AND ZIP CODE
E-MAIL: PHONE#ate r�`Lc�� L NOTES
OPTION 1
OPTION 2
MANUFACTURER:
ee
AH MODEL:
CU MODEL:
MOTXZ-_
COOLING STAGES
r
SEER
TONS
HEATER
SUBTOTAL:
Wv
OTHER DISCOUNTS
Installation shall include:
❑ New reinforced equipment pad
8' Q/U Breaker Brand Size
❑ connect to existing lines
Permit included
Ct/ H Breaker Brand 6e Size. tip
Hurricane Brackets or Strapping
❑ Install new thermostat
❑ Corrugated pipe ft.
❑ Install new H-stat /
❑ Meet all code requirements
❑ Vertical ` %Horizontar `= ""'"❑-'tdrnplete§yste'm"start"up=-"
❑ Filter Rack ❑ Stand
❑ year parts MFG warranty
❑ end Pan ❑ Vert ❑ Horz
❑ year labor BFS warranty
LIVHanging ❑ Attic ❑ Shelf
❑ year maintenance
❑ UV paint
❑ Crane service
Additional work to be performed '2
PAY)
Installation does not include any duct work or line set unless specified orttproposal.
TOTAL INVESTMENT:
J 0
V
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
Card number
O Cash O Financing O Deposit
Exp. date Security
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 material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard practices. BFS will not be responsible for prope damage when removing or replacing
yaorair conditioning system. Including but not limited to attic access, staircases, floors, trim, wall, etc. Any alteration or deviation from above specifications involving extra costs will be executed only upon wn rs, and will me an extra charge
over and above the esfimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, and other necessary insurance. Our workers are fully covered by nsat�n ffoa.
Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby Signatu a
accepted. You are authorized to do the work as specified. Payment will be made as outlined above.
Date of Acceptance:____ Signature - -- -
AII sales are final with no adjustments or refunds. 10yr: MFG Parts Warranty if registered by rustomen-oPly appliesto original purchaser. _