HomeMy WebLinkAboutPaul Samson Permit Application.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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: Paul 8 msbvi
PROPOSED IMPROVEMENT LOCATION:
Address:
V
Property Tax ID #: 33V _ $OZ-0032.— =—O Lot No.
Site Plan Name: Block No.
Project Name: Paw smspYI
DETAILED DESCRIPTION OF WORK:
�► i.11 ► rA LIU,r a 1(1 W.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Y Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing
',,n _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: L4W Sq. Ft. of First Floor:
Cost of Construction: $ (19 Leo . DO Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
W
Name: Robert Noeker
-T.,, `,
Address: uis i ty{_m'sS 11y
r
u
Company: Service Star Air Conditioning and Heating
City: W sal M r�' State:
Zip Code: J� 1 Fax:
Phone No.r1lnl- f5ED—L96C14
Address:18735 E. Colonial Drive Suite 100
City: Orlando State: FL
Zip Code: 32820 Fax: 407-568-2766
Phone No772-770-3733
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail info@servicestarcoolingandheating.com
State or County LicenseCAC055550
It 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: _ Not Applicable
Name:
Address:
City:
Zip: Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
VVVIVtK/ LVIV I KAL I UK AFFIUVIT: 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 1 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�trac o Agent for Owner
STATE OF FLORI[ A
COUNTY OF I IY
Syn to (or affirmed) and subscribed before me of
✓ slcal Pr nce or Online Notarization
this day of 202'. by
&IzA I ZaflI/
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification
(Siignature of NotarfF}ublic- State of
Commissio o,,.....
}ot��to, ANDA LITTLE
_,. Notary Public - State of Florida
Signature ofTontractor ' ense Ho
STATE OF FLOR A
COUNTY OF Ant
SwoXn to (or affirmed) and subscribed before me of
sical Pre ce or Online Notarization
this day of 2022 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
ignature of Notary Pub fU State of Florida )
Notary Public - State of Florida
F MyComm, Expires Jan 19, 2024 oe � ` My Comm. Ex; ills Jan 19, 2024
REVIEW �tj9gl rough ,LZMN;�Assn. UPERVISOR PLAN VEePEdiA�1om Na icSEAcTalc RTI� MANGROVE
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