HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S�`�o LUC E ._
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P ° '0 P `` Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: AC change out
PROPOSED IMPROVEMENT LOCATION:
Address: 1713 York Court Ft Pierce FL 34982
Property Tax ID #: 2421-601-0043-000-
Site Plan Name:
Project Name: Samuel Schroder
[DETAILED DESCRIPTION OF WORK:
AC chanae out York 2.5 ton 17 seer 5 kw heat
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential X
(Affidavit required)
Lot No. 2
Block No. 5
Additional work to be performed under this permit — check all that apply:
V 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: $ 4000 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Samuel Schroder
Name: Paul Cloutier
Address: 1713 York Court
Company: FPL Home Services
City: Ft Pierce State: FL
Zip Code: 34982 Fax:
Phone No. 443-610-5025
Address:7830 Byron Dr #7
City: Riviera Beach State: FL
Zip Code: 33404 Fax:
Phone No 561-946-6835
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail iennlfer.beams(a fplhs.com
State or County License CAC1820030
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:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name.
Address:
Address.
City: State:
Zip: Phone
City: State:
Zip: Phone.
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: FF 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 of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORII4
COUNTY OF orida
Sworn to (or affirmed) and subscribed before me of X Physical Presence or Online Notarization
this 7 day of September 20 21 by
Paul Cloutier
Name of person making statement.
P9f§6Qa1Iy Known X OR Produced Identification
ype o Identifi a ion Produced
(Signat re of Notary Public- State of Florida )
Notary Public State of FiortdaCommission No. (Seal) � Jennifer V BeamsMy Commission HH 023214
w Expires07/23/2024
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