HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 02/01/2017 6L ANNED Permit Number: 1 / 0.z)—o I 0 "l�j�
�.: „3 BY RECEIVED
m St. Lucie Countv
Building Permit Application FEB /6 2017
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 X Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED IIVIPROVE1VlENT LOCATIONS
Address: TBD - Corner of 25th street and Delaware Avenue
Legal Description: Please see attached.
Property Tax ID #: 2408-441-0001-010-3 Lot No.
Site Plan Name: Elks Park Block No.
Project Name: Elks Park Concession Stand air conditioning change out
Setbacks Front N/A Back: WA Right Side: WA Left Side: N/A
"D.ETAI'LED DESCRIPTION `OF WORK.
Remove one 5 ton air conditioning unit and replace it with 2 split systems - 81/2 tons total
)ko '�?eerr SKW • CEIKs
CONSTRI I''CTION''INFOR`MATION: "
L IHVAC U Gas Tank
ZElectric 0 Plumbing
Total Sq. Ft of Construction: 1260 Sq. Ft.
Cost of Construction: $ $15,000.00
tnisperma— cnecKau apply:
❑Gas Piping _ Shutters Windows/Doors
Sprinklers Generator Roof = Roof pitch
S Ft. of First Floor:
Utilities: �Sewer DSeptic Building Height:
OWNER%LESSEE;
;CONTRACTOR ,-
Name St. Lucie County
Name: Owner builder- St. Lucie County
Address: 2300 Virginia Ave
Company: St. Lucie County
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 462-1444
Phone No. 462-1432 Bob Ettswold, Projcect Manager
Address: 2300 Virginia Ave
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 462-1444
Phone No. 462-1432 - Bob Ettswold, Project Manager
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
17Ca-0in�>_
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
- --Zip,
---- -- -.-_. i-Phone------
Zip: Phone: — - - —
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
-Add[esg — -
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 such
prohibit
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 our Notice of Commencement.
. YaZRL F-
1 ng a#ur�g j Lessee Contracto as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF `+: w e % E
COUNTY OF
The forgoing instrument was acknowledgedhefore me
The forgoing instrument was acknowledged before me
this �p day of ol t20 \ ' by
this _ day of . 20_ by
rrl P r,< ( -, +-te r e 2.
(Name of person acknowledging)
(Name of person acknowledging)
(S'ig a of Notary Public- State of FAffla)
(Signature of Notary Public- State of Florida )
Personally Known —�e OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
_.g,• kf3AtdBELLAMY "_`
Produced
✓: Commissjon_�,F.F194056; -,
Commission No. �+ a€ ErpireslfLfl99ddllyy29 2019
Commission No. (Seal)
_
_-' '',P„l;qBrcdeE llvu Troy ien lreurann 89W9S1019.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
y
'
RECEIVED
1-
DATE
Aye
COMPLETED
ei?
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED )�/
Date: 02/01/2017 SCANNED Permit Number: l / (%-)—O / OCI
�- BY RECEIVED
St. Lucie Countv
Building Permit Application FEB /6 2017
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 X Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: TBD - Corner of 25th street and Delaware Avenue (Elk's Park)
Legal Description: Please see attached.
Property Tax ID #: 2408-441-0001-010-3
Site Plan Name: Elks Park
Proiect Name: Elks Park Concession Stand air conditioning change out
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
Remove one 5 ton air conditioning unit and replace it with 2 split systems - 81/2 tons total
1e deer, S KVJ • CE7 I Ks ;
Haaaionai work cO oe
OHVAC
errorrnea
_Gas
unaeF finis
Tank ❑Gas
Permn— cnecrc an n-
Piping _Shutters
apply:
Windows/Doors
Electric
0 Plumbing
Sprinklers Generator
Roof Roof pitch
Total Sq. Ft of Construction:
1260 Sq.
Ft. S Ft. of First Floor:
Cost of Construction:
$ $15,000.00
Utilities.
Sewer
Septic
Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name St. Lucie County
Name: Owner builder- St. Lucie County
Address: 2300 Virginia Ave
Company: St. Lucie County
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 462-1444
Phone No. 462-1432 Bob Ettswold, Projcect Manager
Address: 2300 Virginia Ave
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 462-1444
Phone No. 462-1432 - Bob Ettswold, Project Manager
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
Owner/Builder- St.Lucie County will beusing the following sub -contractors for the
(Company/Individual Name)
project located at 2408-441-0001-010-3 (Elks Park)
(Street address or Property Tax ID #)
It is understood that if there is any change of status regarding the participation of any of the sub -contractors
listed below, Iwill immediately advise the Building and Zoning Department of St. Lucie County.
Trade
Name of Company/Contractor
St. Lucie County/
State of Florida
License Number
Electrical
Matula Electric
James Matula
1010 West Midway Rd., Ft. Pierce, FL 34982
EC13001643
Plumbing
HVAC/
St. Lucie County - Owner/builder
N/A
Mechanical
2300 Virginia Ave., Ft. Pierce, FL 34982
Roofing
Gas
OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER:
Revised 0729/2014
.SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION`.
DESIGNER/ENGINEER:
Name: Wanda Gahn RegNo.CAC058393
_ Not Applicable
MORTGAGE COMPANY:
Name: Nolappllwble
_ Not Applicable
Address:
Address:
City: FortPierce
Zip: Phone:
State: FL
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name: Nolapplimble
_ Not Applicable
BONDING COMPANY:
Name: Nolapplicabie
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 covenan hat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any strictions which may apply.
Inconsideration of the granting of this requested permit, I do hereby agree that I will, in I respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie Coun Amendments.
The following building permit applications are exempt from undergoing a full con rrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and a essory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Comme cement may result in your paying twice for
improvements to your property. A Notice of Commencemen ust be recorded and pasted on the jobsite
before the first inspection. If you intend to obtain financin consult with lender or an attorney before
commencing work or recording vour Notice of Commenc ent.
STATE OF FLORID
COUNTY OF 5�•
The forgoing ins
this lW day of
20
WIN
(Name of person acknowledging )
d
(Signature of Notary Public-Oat
e of Florida )
Personally Known " R Produced Identification
Type of Identification Pro ucec
Commission No. FI % IO �MP0,, Danielle
,.. A �ealbommiesion i
Revised 071/"v�/2014
- -
s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
No.
(Seal)
REVIEW
FRONT
ZONING
SUPERVISOR
PLANS
VEG ATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVI
REVIEW
REVIEW
DATE e.
COMPLETE
INITIALS