HomeMy WebLinkAboutIsmailoffPermitSLC_20210921.pdfAll APPLIC77e,
FO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:HVAC Equipment ChangeOut
Address: S:7/;/3 /?'a/i ///i✓
O l
Property Tax ID #: ���1 ` �'77✓���~ Lot No.�?�
Site Plan Name: Block No.
Project Name:
Like for like AC replacement
Additi nal work to be performed under this permit— check all that apply:
7Mechanical _ Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: �y �d _ Sq. Ft. of First Floor:
Cost of Construction: $�� Utilities: _Sewer _Septic Building Height:
Name AVIIZ' a1��
Address: I%f IF /
City: ci ACi/ State:/ C
Zip Code: Faaxx:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:Steve Smith
rrmmnanv:Steye Smith Air Conditioning
Address:8001 Eden Road
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-461-2036
Phone No772-461-1425
E-Mail stevesmithac@aol.com
State or County LicenseCAC1813454
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
"DESIGNERENGINEER: _ 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:
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
tf cture. conflict
lease consult withpyolur Home Owners Association land reviewyyour deed or any restrict that
wh ch maor
aprohibit such
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 ayr)attgv before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF F60RID
COUNTYOF
Sworn to (or affirmed) and subscribed before me of ><JyFiysical Presence or Online Notarization
this 3!d� , v l •~ /1 0� byr I y
Name of person making statement.
Person Known OR Produced Identification ��•` POAWA/ �
Type of I ntification Produced f-'lI DL S'S'.30 7$IS50%10 : �.�,
^ Qom, 'N07ARY ;
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re of
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