HomeMy WebLinkAboutSmith, N - SLC Permit App Notorized.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LUCL
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: HVAC Like For Like Change Out
PROPOSED IMPROVEMENT LOCATION:
Address: 7428 Bob 0 Link Way Port St. Lucie, FL 34986
Property Tax ID #: 3322-505-0047-000-9 Lot No. 38
Site Plan Name: MAIDSTONE (PB 43-11) LOT 38 Block No.
Project Name: Smith Like For Like Change Out
DETAILED DESCRIPTION OF WORK:
Like for like a/c system change out using Lennox 5Ton Split System SEER: 15.1 Heater: 10KW
CU Model# ML14XC1-059 AHU Model# CBA25UHV-060
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
X_Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ $7,427.19
Gas Piping
_ Sprinklers
_ Shutters _ Windows/Doors _ Pond
_ Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Nicole Smith
Name: ROBERT CAMPBELL
Address: 7428 Bob O Link Way
Company: Breathe Healthier Entemrises Inc
City: Port St. Lucie State: FL
Zip Code: 34986 Fax:
Phone No. (845) 242-8259 E-
Address: 7886 SE ELLIPSE WAY
City: Stuart State: FL
Zip Code: 34997 Fax:
Phone No 772-600-715t
Mall: nsmflh2418Qgmai1.mm
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail SUPPORT(a1BREATHEHEALTHIERAIR.COM
State or County License CAC058685
it value of construction is 250D 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: X Not Applicable
MORTGAGE COMPANY: X Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: X 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, 1 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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Contra r - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF st.Lude
Sworn to (or affirmed) and subscribed before me of X
Physical Presence or
Online Notarization
this 23 day of March , 20 22 by
ROBERT CAMPBELL
Name of person making statement.
Personally Known OR roduc d Identification
Type of Identification
(SignatureLoq6N of Florida)
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