HomeMy WebLinkAboutSmith, Pat - SLC Permit App NotorizedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/14/21
Permit Number:
LUCM
U 11T M r c Aw Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: HVAC Like For Like Change Out
PROPOSED IMPROVEMENT LOCATION:
Address: 5771 Travelers Way Ft. Pierce, FL 34982
Property Tax I D #: 3410-503-0094-000-7
Site Plan Name:
Project Name: Smith, Pat like for like ac chnage out
DETAILED DESCRIPTION OF WORK:
Lot No. 26
Block No. C
Like for like Champion 3.5 Ton 17 SEER Split a/c System with no duct work:CU Model #: TC7B4221S
Amu Model
AHRI#Heater 10KW
New Electrical Meter
Second Electrical Meter
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit —check all that apply:
_KMechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 5,200.00
—Gas Piping
_ Sprinklers
_Shutters —Windows/Doors _Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Pat & Raymond Smith
Name Y
Robert Campbell o o
Name: R,Pan,e Haabh pr FmP.1prices Inc
Address: 5771 Travelers Way
Company: Breathe Healthier Enterprises Inc
City: Ft. Pierce State: FL
Zip Code: 34982 Fax:
Phone No. 772-343-9763
Address: 7886 SE ELLIPSE WAY
City: Stuart State: FL
Zip Code: 34997 Fax:
Phone No 772-600-7151
E-Mail: rayandpatsmith@gmaii.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail SUPPORT@BREATHEHEALTHIERAIR.COM
State or County License
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: X Not Applicable
MORTGAGE COMPANY: X Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: X 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 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 attornev before commencine work or recording your Notice of Commencement.
2-Swith
A4a4t-cam0ae&
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF MARTIN
COUNTY OF MARTIN
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
X Physical Presence or Online Notarization
this 14 day of October . 2020 by
this 14 day of ocaber , 2020 by
Pat Smith
Robert Campbell
Name of person making statement.
Name of person making statement.
.,,,,1��►�
Personally Known x Q Ft' ' IMel Fitt
Type of Identlficatlo • : •• 1�
W.
�pY A i
Personally Known X -f ;Wd __ll,, ki &aJftL
TIdentification• : :. -- rt .: N
Type of N 124417
:�,
..
Produced •' MYCmwd mExpkes:
.. M
Produced '��''• •'�
•.... EXph L
Mey 2, 2025
'��ntill M8y 2, 2025
(Signature Va P tate o Florida)
(Signature of o P a of F o
Commission No. L (Seal)
Commission o. _ 4 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 5/e/20