HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�- -'9--
` - 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
PERMIT APPLICATION FOR: Gorman-996
PROPOSED IMPROVEMENT LOCATION:
Address: yyou o ucean unve unit 19ul
Property Tax ID #: 4502-702-0081-000-9
Site Plan Name:
Project Name: Gorman-9960
DETAILED DESCRIPTION OF WORK:
Install 14 seer 2.5 ton Heat Pump water source Climte Master HVAC system
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 5848.00
X
Lot No.
Block No.
Windows/Doors Pond
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameJeff Gorman
Name. LUKE WALKER
Address:9960 S Ocean Drive
Company: TREASURE COAST AIR
p Y�
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No.772-380-3323
Address: 1055 S.W. MARTIN DOWNS BLVD
City: STUART State: FL
Zip Code: 34990 Fax: 772-288-7046
Phone No 772-692-1701
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If of'n #e ...... ..:.. 'fenn _
E-Mail TCAC1990@ATT.NET/TCACSVC@ATT.NET
State or County License CAC058476
...,..,, wineuj %-urnmencementIs requlrea.
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
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x 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 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 recordin Notice of Commencement.
Signatur of Owner/ es�¢e/Contractor as Agent for Owner
Signature of C actor cen e Holder
STA ORIDA
COUNTY OF �M12%
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STATE O IDA M
COUNTY OF_ / ,A4 Tlr,,V
! S n to (or affirmed) and
Physical PreseD;p or
subscribed before me of
Online Notarization
Swor to (or affirmed) and subscribed before me of
Physical Preseaceor
this day of
by
Online Notarization
this _14 day of ,/��/N , 20/220� by
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Name of person making statement.
Name of person making statement.
Personally Known
OR duced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of otary Publi
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(Signature Notary ublic- State of Flor$' - . oMi,�lssioN' .
Commission No.
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Rev. 5/672D—