HomeMy WebLinkAboutDuharte, Roxane - Permit Application 1112021 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:11/1n/2n0/221 @ Permit Number:
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Building Permit Application
Planning and Development5ervices
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 FORA/C Change Out
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Address: 3870 N Highway A1A Apt 101 Hutchinson Island, FL 34949
Property Tax ID#: 1423-805-0001-000-0 Lot No. 101
Site Plan Name: Block No. 1
Project Name: A/C change out
5 a 4
like for like water source heat pump change out. 3 ton.
New Electrical Meter Second Electrical Meter
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:$ 6250 Utilities: —Sewer _Septic Building Height:
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Gi 'N r�GTOR F.
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Name Roxanne Duharte Name:Anthony Fenn
Address:3870 N Hwy A1A 101 Company:Assured Air Conditioning
City: Hutchinson Island State:_ Address:278 NE Surfside Ave
Zip Code: 34949 Fax: City: Port St Lucie State:FI
Phone No.5616676511 Zip Code: 34983 Fax:
E-Mail: Phone No(772)202-2005
Fill in fee simple Title Holder on next page(if different E-Mailanthony.fenn@assuredairconditioning.com
from the Owner listed above) State or County License CAC1820274
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.
SUPPLEMENTALCONSIaUCTJO,N LIED LAIN INE_'RaMyAT1O,N
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 Countyy 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 thejobsite 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.
ignat F6/. r/Lessee/Contractor as Agent for Owner Signature CQntpaft or/License Holder
STATE OF FLORIDA �� � STATE OFFLORIDA /
COUNTY OF COUNTY OF STL(/
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
X Physical Presen a orb Online Notarization xPhysical Presen or�9 line Notarization
this��'day of,�/ rf Z .2020 by 2020 by
Name of person aking statement. Name of person makin atement.
Personally Known OR Produced Identification L Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
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