HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INF M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
/7 � Z� Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential
PERMITTYPE:HVAC Equipment ChangeOut
Address:
Property Tax ID #:
Site Plan Name:
Project Name: _
Lot No.
Block No.
Like for like AC replacement / % % / /
/lir, ��. �C Z/e96�'h �` dig / Lei Y
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping —Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $
Roof Pitch
Utilities: —Sewer _Septic Building Height:
Name
Address: �yt� ui X -
City: �l/�'' State: i �-
Zip Code: Fax:
Phone No. IZY7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Steve Smith
Company: Steve Smith Air Conditioning
Address:8001 Eden Road
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 772-461-2036
Phone No772-461-1425
E-Mail stevesmithac@aol.com
State or County LicenseCAC1813454
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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 lendw or a"ttorOy before commencing work or recording our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF F60RID
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this ��day o t `t 2014 by
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Name of person making statement.
Person Known OR Produced Identification �POAWN
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Type of I ntification Produced L� pL S530 7$IS60� a0 �` ��
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