HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
9 Lre
'��i�U"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 CBDG Funding
PERMIT APPLICATION FOR:
RROPC}SEp,1!l?QUEM_,,,NT
Address: 5705 Paleo Pines Cir.
Property TaxlD #: 1312-500-0020-000-2 Lot No. 19
Site Plan Name: Block No.
Project Name:
EQUAL AC Change out - 4.0 ton; 16 seer; 5-10 KW Heater
New Electrical Meter Second Electrical Meter (Affidavit required)
CQIVSTRiJOTION INFpRtvlA'f1C7N~� � � � fi � � � v
Additional work to be performed under this permit —check all that apply:
x 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: $ 4600,00 Utilities: _ Sewer _ Septic Building Height:
rE�11UN�R/1-ESSEB� h ' •
CLiN'TR�CTOR
Name Jacqueline Foshay
Name: Daniel J Osullivan, II
Address: 5705 Paleo Pines Cir.
Company: Local AC, LLC
City: Fort Pierce State: FL
Address: 55 W Church St. Apt 2805
Zip Code: 34951 Fax:
City: Orlando State: FL
Phone No. E-
Zip Code: 32801 Fax:
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail service@local-ac.com
from the Owner listed above)
State or County License CAC1820154
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.
S�PP�.�1�I�I�TAL CONSTR��IGT1Q�t
41�N LAW �N��F�MATI�xN�
a
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:
L
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 attornev before commencing work or recording vour Notice of Commencement.
Daniel Osullivan
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor to (or affirmed and subscribed before me of Physical Presence or Online Notarization
this 34 day of 20-2,1 by
IDOVtcc\ D 4ky�
Name of person making statement.
Personally Known 'AC�OR Produced Identification
Type do ft
gn a of ry Publ c- State of Florida)
tPxy Asg Jonathon Thomas
Commission No. (Seal) ° NOTARY PUBLIC
ESTATE OF FLORIDA
Comm# GG141189
�NCF 1`��� Expires 9/1812021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
JS
u�i�