HomeMy WebLinkAboutapplicationAll APPLICABLE NF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 27 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMiTTYPE:HVAC Equipment ChangeOut
Address:
PropertyTaxlD#:
Site Plan Name:
Project Name:
I ike fnr like AC replacement
Lot No._�
Block No.
Additio al work to be performed under this permit— check all that apply:
7echanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator — Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
N a m e e'2=r
Address:
City: �,l �l/��' State: _
Zip Code: �/1��� Fax: l
Phone No.
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 License CAC1 813454
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 lendor or a"ttorOy before commencing work or recording your Notice of Commencement. __
Signature of Owner
STATE OF F60RIDA
COUNTY OF 06� 1
as Agent for Owner
Sworn to (or affirmed) and subscribed before me of
this ot 20'� by
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Name of person making statement.
� P�ysical Presence or Online Notarization
PersonalKnown OR Produced Identification .`
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ication Produced^f—'lI DL S'S3o 74�55Ot �o: �. �
NOTARY ' 'LLIC
ture of Notary Public--�e4f Florida )
omission No.'11 V 1'1 %-L• (Seal)
REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
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