HomeMy WebLinkAboutPermit App for 5167 N Hwy A1A 701.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICA
Date: 3/28/22
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Building
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
N TO BE ACCEPTED
Permit Number:
rmit Application
Commercial X Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 5167 N HIGHWAY A1A 701
Property Tax ID #: 1411-709-0047-000-2
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Like for like AC changeout 3 ton 14 with 5 kw heat
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit— check ill that apply:
_Mechanical _ Gas Tank _ Gas Piping — Shutters _ Windows/Doors _ Pond
— Electric _ Plumbing _ Sprinklers _ Generator Roof
Pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 4,200.00 Utilities: _ Sewer Septic Building Hairrht-
OWNER/LESSEE:
----j
CONTRACTOR:
Name Randy & Kathy Albright
ame: Shyan Wojtczak
Address:341 Liberty RD
Company: Cool Air Solutions of Florida, Inc.
City: Gordonville, TX 76245 State: _
Zip Code: 76245 Fax:
Phone No.903-815-9341
Address: 7901 Santana Ave
ity: Fort Pierce
State: FL
i 34951
p Code: Fax: 772-801-5398
hone No 772-634-0491
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is 2500 or mnrP_ a RFrnRn�n ��,..:,.,. _r �_
-Mail coolairsol@gmail.com
State or County License CAC# 1819009
._
cnea icqulreu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commen ement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:_
Address:
City:
Zip:
GINEER: _ Not Applicable MORTGAGE COMPANY: T Not Applicable
NIAMP-
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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
structure. conflict
lease c nsult with applicable
Hlome Owners Associatio andrreviebylaws
y ur deed for any restrictions which may al. prohibit such
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 recording your Notice of Commencement.
I
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Signature of Owner/ Lesseex ntracfor as Agent for Owner
Signature of Contractor/,Li r s Holder
STATE OF FLORIDA,` . STATE OF FLORIDA
COUNTY OF a COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this , �tJday of i 't iCi( C t '�f -3 ,-2020 by
Name of°person making statement.
Personally Known OR Produced Identification
Type of identification
Pr duced
(Signature of Notary Public- State of Florida )
Sworn to (or affirmed) and subscribed before me of
_-- Physical Presence or Online. Notarization
this day of Lr .$ a2020 by
Name of `person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (--'11C �' r ) arc5tale n
�
Amanda PSan(Jar Ot
My C+ommission GG 11256
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REVIEWS FRONT Tl"' VEGETATI
I COUNTER IRO REVIEW NS I REVIEW
DATE
RECEIVED
DATE
COMPLETED
ary Pu&Qe of Florida
,anda P Sandorson
C,,ni nission GG 211256
REVIEW I REVIEW