HomeMy WebLinkAboutSt. Lucie Realty - Vapor Rocket 897C - AC changeout permit applicatiion.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
N.J. CUED
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;� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential �f
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:'tubJeAkr
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Address: Address: `(%iQ IS_ ElV /a4L'-
Property Tax ID#: -57r0001-010--� Lot No.
Site Plan Name: Block No.
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Project Name: t (Cf� `� �7 ' V Q�r f
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New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit — check all that apply:
(Mechanical Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 5553 Utilities: —Sewer —Septic Building Height:
x+xM�'x'4 R4xx
Name CR Name: 15�
AdR' � � pYdress:. �p S fd Com an �n
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City: D1/ V.State: _ Address: /so) i
Zip Code: 62— Fax:�"7Zz _399b-9'?"? City:- pr Stater
Phone Na-7 � Z 3Gitb -�'�2<- Zip Code: Fax:Z%2 3�` 'C� i��
E-Mail:90�2<4itiiGi'n lL2+r ,`('QncasLI- a Phone No -7Z`
Fill in f e simple Title Holder on next page ( if different E-Mail r1
from the Owner listed above) State or County License
If 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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:_
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: _
City: State: _
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
uiith Innrlor nr nn nttnrncv hcfnrc rnmmpnrincr wnrk nr recording vour Notice of Commencement.
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Si f Ow r Lessee/Contractor as Agent for Owner
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STATE OF FLORIDAt I /' ,
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STATE OF FLORIDA.-1, C
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Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
✓ Nntarization
Physical Pr Bence or Online Notarization
2020 by
Physical Presence .o�r - Online
this � day of 0` Gl C �'L 2011 6y
th�Z� day of
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Nam of person m kings atement.
Name of person r7aking statement.
Personally Known OR Produced Identification
Personally Knownl,/,' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary Publi(Signature of Notary Publi
P W St te� Flord9 �,►.• N Notary Public State of FW48Commission
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No. �G983089 ommission No. Cra(ggq ossman
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZO