HomeMy WebLinkAboutBuiliding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10-4-2021 Permit Number: l�J
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building Permit Application OCT 0 4 2021
Planning and Development Services _t.Lucie County
Permitting
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:
PRC?PpSIt !(V(PRtQ1lEM NT LCJCATI;,t
Address: 2109 NW GREENBRIAR LANE PALM CITY FL 34990
Property Tax ID#: 4425-701-0053-000-5 Lot No.
Site Plan Name: Block No.
Project Name: ROBINSON AC CHANGE OUT
DEAILED DESCRIPl-ION C}E WORK%- R
AC CHANGE OUT LIKE FOR LIKE 5 TON 16 SEER AMANA SYSTEM 10KW HEAT(AHU ATTIC LOCATION )
New Electrical Meter Second Electrical Meter
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C0NSTRUCT C N lN'FORMATEON
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Additional work to be performed under this permit—check all that apply:
_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: $ 7200 Utilities: —Sewer —Septic Building Height:
01IVNERJLESSEE. CONTRACTOR ;
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Name STEVEN ROBINSON Name: DAVID SMITH
Address: 2109 NW GREENBRIAR LANE Company:ONE CALL AIR CONDITIONING
City: PALM CITY FLORIDA State:_ Address:968 SW PROVINCETOWN LANE
Zip Code: 34990 Fax: City: PORT ST LUCIE State: FL
Phone No.302 598 5360 Zip Code: 34953 Fax:
E-Mail: Phone No 772-201-3885
Fill in fee simple Title Holder on next page(if different E-Mail ONECALLCOOLING@GMAIL.COM
from the Owner listed above) State or County License CAC1817403
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.
SUPPLENiENTALCC►NSTRUCTION 11EIU LAW 1NFORMATIOIV
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:
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 attorney before commencing work or recording ur Notice of Cohmencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Sign of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI t
COUNTY OF COUNTY OFF
Sworn to(or affirmed) and subscribed before me of Sworn to(or affirmed) ,nd subscribed before me of
Physical Presence or Online Notarization _ P ysical Pre ce Y r Online Notarization
this day of ,2020 by this day of 202§ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida ) (Signature of Notary
KAR-EN S. NIELSEN
Commission No. (Seal) Commission NO. °�P sState of F� Notary
mi Public
Coms o GG 207484
My Commission Expires
22
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