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All APPLICABLE INFO MUST BE COMPLETED FOF; APPLICATION TO BE ACCEPTED I
Date: )� I1�,�—( Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commerciat Residential
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
'A ION FOR:
i
PROPOSED IMPROVEMENT LOCATION:
Address: l 02-0o S. OL-eA r. 'Dr. Oi' Sp
Property Tax ID#: 45��^5)9-0Oy(n� Lot No. I
Site Plan Name: `, Block No.
Project Name: F—),iry\A (ZLii&t",Le— WI� l
DETAILED DESCRIPTION OF
aa3�'a
Gk rr c i iA-, a U'V � 3-
!
New Electrical Meter Second Electr afteter (Affidavit required)
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CONSTRUCTIO
Additional work to be performed under this pe`mit —check all that apply:
_Mechanical _ Gas Tank _ Gai Piping _ Shutters _ Windows/Doors _ Pond
_Electric ( Plumbing _Sptinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 oso• °p Utilities: _ Sewer _Septic Building Height:
OWNER/LESSEE
,CONTRACTOR:
Name:_f�YY'-A Lc, mac; . u'
Name V_'
n
Address: I{Icgy /+,in)f=±:), L^k Ci(z.-
Company: L� Evt�v(1�Iia�d�b�h
City:ytrp (fin, cj. Itate:F"—
Zip Code: 32A lb'.)- Fax:_
Phone No. -:I;7^'2'1-4 "S4c)'r
Address: 6 ' ) %� .jr' D -J'\K
City: S ` State: w
Zip Code: 3-195 a Fax:
E-Mail:
Phone No 13'2 ^ Lilo ► — 13 13
Fill in fee simple Title Holder on next page ( if c 'fferent
E-Mail_i
from the owner listed above)
State or County License C FL ) y; U-+{ 5-
If value of construction is 2500 or more, a RECORDE' Notice of Commencement
If value of HAVC is $7,500 or more, a RECORDED No ;i.,e of Commencement
is required.
is required.
SUPKC ...ENT 4C T,R.QNLI�T,
,
FORMATION:
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
• •
Address:
City:
State:
City: State:
Zip: Phone
`.
Z(p: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
V .
Name:
Address:
-=
Address:
City:
i
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obEaln 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 an applicable Home Owners Associatlon 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 3pilding Codes and St. Lucie County Amendments.
The following building permit applications are exec )ot from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wal'.s; 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 your Notice of Commencement.
Signature of Owner/ Lessee/ n ctor as Agent'forAi caner
STATE OF FLORIDA COUNTYOF
Sworn to (or affirmed),and subscribed before me bf ""'Physical Presence or Online Notarization
this � day of o hA-e— 20 u by
Name of person making statement.
Personally Known �_ OR Produced Identificption
Ty Identification Produced
C C�r'�'1►'1P / i
(Signature of Notary Public- State of Florida
Commission No. j
�T 1'1 210 (Sealy :.
-JESSICA GROVER
Notary Public -State of Florida
Commission # HH 119064
My Commission Expires
April 19, 2026
REVIEWS FRONT ZONING SUPERVISOR PLANS
..__
COUNTER REVIEW REVIEW REVIEW
VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW
❑COMPRESSOR
O SUCTION PS
❑HEAD PS
OVOLTB AMP:
❑ ELECTRICAL CONNECTIONS
O CONTACTS TIGHT& CLEAN
O OILLEVEL& CONDITION
❑ CONDENSOR COIL
O CLEAN COIL & CHECK FIN COND.
GENT_°F LVG°F
❑ REFRIGERANT
❑rz U100a
❑ FAN AND MOTOR
❑ VOLTS AMPS_
❑ ELECTRICAL CONNECTIONS
O CONTACTS TIGHT & CLEAN
O FAN PULLEYS (ADJUST BELT)
O CHECK LUB BEARINGS a MOTOR
❑ EVAPORATOR COIL
0 CLEAN & OIL & CHECK FIN
OENTDB_°F LVGDB —"F
Q ENT Wa--FI LVG WB — °F
OCONDENSATEAREAS
O hISF'ECTBCIFiW INtANPAN
O P6PECT&CLEPNORPN
DAIRFILTERS -
QC EPNED OREPtACFD
HLTERSRE
❑ HEATING ASSY.
❑ BUPoJER 8 FEAT E%G VNGHi
❑ FLEL SIIPFl.V & Pf iESSIA�
0MOTASSEMfsY -
❑FIAMEFOIUSi&ENT
"OPRIM1LUNRF3/Ya fLUE
❑FAN & IIAgrSVrfiCH OPER
❑BLONHiASSEMELY
❑RV VALVE
OSIHPFEAT
ODEFROSTCYCLE
❑ ELECTRICAL COMPTS.
UOVERJ ❑CCMACmRS
Cov>gaaw DppEsssvmat
❑THERMOSTAT
COIL URalJvf
ORELOCAM
O DUCT SYSTEM
STAMPRESSURE
FEIIAdJ SUPPLY
FLIER 1NITRATNG
TEAPWBVENT�_ -.
Manufacturer
BM OR#
IFS& Rev. 612020
-BROWARD FACTORY SERVICE _ 111 V , _
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J6;'30 C50
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_'957
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COVERAGES PE.
PREVIOUS :ti A, Spill 4i on ... 4 1.5 t RAISE Ta!;
CALLS WF4= fm'_ATEP,YHE1. = -AT nr'ar Ora mm; P[
QUOTE WH
SERVICE rE. ?^F_a F_ __ =,r __ ;e •-v �.
REQUEST Ail,
tr *Tn - t
Ail,• BLED V$liZ
PART NEEDED
I I r I vc� Yl
TECH
p2
PAYMENT
DESCRIPTION OF WORK
Lta..- A I L
/1. ,ir rl ..\ r
' THE r TIME
N / / OUT
b
TIME TIME
IN OUT
I have received and agree to the terms and conditions of my contract, and I understand
that this service is a claim gdainst my contract
PARTS WARRANTY
All "I as recorded are vnkd as par manufacturer specifications.
LABOR GUARANTY
The labor charge as recorded here
PARTS
relative to the equipment serviced as noted, is guaranteed for a period of 30 days -
LABOR
We do not, of course, guaranty other park Nan those We Install. If repairs later become
necessary due to other defective pans, they will be charged separately.
No guaranty on any drain stoppages.
SERVICE
> CHARGE
BFS WILL NOT BE RESPONSIBLE FOR PROPERTY DAMAGE WHEN
REMOVING
OTHER
PART NEEDED TO PERFORM NECESSARY SERVICE WORK AND I ACCEPT DISCOUI
5 PERFORMED SERVICE AND/OR CHARGES AS BEING SATISFACTORY TAX
O•# .i 6, All sales are final with no adjustments or refund.
4VAJ`n • .
P.O.# X ... •
i CUSTOMER SIGNATURE
6
www.browardfaclory.com
Licenses: CAC056778, CAC056774, CAC057400, CFC05686/ a GUi? L , ; ,;t. 0046467, 280095, 279402, 289si;-t; 01)81418 000,414; EC
CALL#
SCHEDULED
DATE II J _
5
O COMPLETE
O PARTS ORDER
❑NOTHOME
ORESCHEOULE
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