HomeMy WebLinkAbout13827 S Indian River Dr, 61, permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/15/2021 Permit Number:
9 o LUC
_o
r ° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: AC Change Out
PROPOSED IMPROVEMENT LOCATION.
Address: 13827 S Indian River Drive, 61
Property Tax ID #: 450M05-0061-00M Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK.
AC Change Out 2 ton 14 SEER package unit 5 kw heat
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION.
Additional work to be performed under this permit — check all that apply:
V Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 552 Sq. Ft. of First Floor:
Cost of Construction. $ 6233 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Robert & Judith Daugherty
Name: Paul Cloutier
Address: 13827 S Indian River Drive, 61
Company: FPL Home Services
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 609-402-1773 E-
Address: 7830 Byron Dr, 7
City: Riviera Beach State: FL
Zip Code: 33404 Fax:
Phone No 561-747-5740
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail chuck.johnson@fplhs.com
State or County License CAC1820030
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:
Name:
_ Not Applicable
MORTGAGE COMPANY. _ Not Applicable
Name:
Address:
_
Address:
City:
Zip:
Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE
Name:
HOLDER.
_ Not Applicable
BONDING COMPANY. _Not Applicable
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and sub cribed before me of Physical Presence or Online Notarization
this'Eday of VQYP-e-ti° 20,;�,/ by
Name of person making statement.
Personally Know OR Produced Identification
Type of Iden ' ' a ion roduced
(Signature of�Qotary Public- State of
Commission No.
'�� n�s� Notary Public State of Florida
Chuck Johnson
� r_; ., 8� My Commission HH 018578
?oi� Expires 07/07/2024
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