HomeMy WebLinkAboutSUBMITTED PAPERS772-770-0064 ARS ' '6;12 09-17-2014 2/6
ALL AP A NF% UST BE COMPLETED FOR APPLICATION TO 13E ACCEPTED
Date: r ( SCANNED Permit Number.
BY
St. Lucie County
. _. .
Building Permit Application
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 Residential
PERMIT APPLICATION FOR: Two Select from dropbox, click arrow at the end of line
g
Address:.,,(
Legal Description:
Property Tax ID #: ?(_. 9 - �.1. A. -- c 7 (D i-) — d --,Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Aaaiti aI work to oe errormea
AC Gas Tank
unaertrns permit - cnecK all
❑Gas Piping
apply:
Shutters
❑Windows/Doors
_
Electric 0 Plumbing
OSprinklers
L� Generator
0 Roof
Total Sq. Ft of Construction: 5 Ft. of First Floor:
V
Cost of Construction: UtiIities:t] Sewer 11 Septic Building Height:
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Name 1
Name: .�
Company
Address:
City: State: Pi
Address: U•,-,-itk1 f I
Zip Code: Fax:
City: \[R yo Stater
Phone No. L, -I is5^ C)
Zip Code: U Fax: /'pi-) -iG1�-mc w
E-Mail:
Phone No. -ImZ
Fill in fee simple Title Holder on next page (if different
E-Mail: a) (AYJ • C 0M
from the Owner listed above)
State or County License: G1 .
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
772-770-0064 ARS
1A,18:33 09-17-2014 3/6
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
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 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 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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/A nt Lessee ignature of Contri36t6 /License Holder
STATE OF FLOR1I 4A STATE OF FLORIDA
COUNTY OF c` " - I p .10 . COUNTY OF L-�
The f r oing instrument w s cl now ged before me Thefor r oing instrur�gnt was acknowledged before me
this day of �, 20 14 by this H day of , by
(Name of person ackno ed Aing) (N
of Nothiry Public- State
of
Personally Known) .� OR Produced Identification�.J Personally KnownOR Produced Ide7ftifit'dtion
Type of Identification Produced Type of Identificatio6 Produced
Commission No. Ge ii itils ion No.�� 13 � Z� ^°
�►s� >u� o;'"� •, a ELLY M MC
ELLY M MO NEY t
•i I` MYCOMMISSION
EXPIRES June 10. 2018 ?l EXPIRES June
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
2018
772-770-0064 ARS t 1_Ai21:05 09-17-2014 5/6
Y Nu SS�
'IN TALLATION WORK ORDER (772) 567-3100
_ CMC1249753. CFC1428283, CAC045878 (321) 409-0908
Customer Name Date Call Slip 4
Address City State Zip Code
( S\L:,i, )18 --)C)Z 0 t ) 91 11 / ►y
Phone Phone Scheduled Installation Date
We hereby agree to furnish and you agree to pay for all necessary equipment, materials and labor to install the following items listed in accordance
with the conditions and specifications set forth on the reverse side.
[L Lli Option #1 13s ,c Option #2 Option #3
3T�� SLG
II W/ (O KW W1 KW W/ KW
�SNi1� i �K
PRICE 5(DN $ $
OPTIONS + + +
UTILITIES "
Lk -
TOTAL $ �% (D 00 $ $
WarrantyAb Comp 00 Parts. .._ tabor Warranty: —Comp — Parts _ Labor 'Warranty: —Comp— Parts —.Labor
Refrigerant recovered and disposed of as required by law. Complete clean up including use of floor savers to protect your home .
and removal of existing equipment. All work completed is done in accordance with existing codes and permits, as required.
Weatherproof disconnect
❑
.. La ^l, a (
) Reconnect drain line
Supply plenu econn New
Lifetime equipment slab
❑
Reconnect NeW
:.,y. r;; w _:
❑ P v r ,y.,.,..� p k
Return plenum ernnec New
Sound isolation pads
Expansion valve
❑ C_e7, n�aveT� t (pan & float)
Remove existing eq ' ment
Liquid tite conduit
Hurricane Straps (o_) Main drain safety switch
Undercoating
❑
sta! t K4
Digital t-stat
® Seal new connections
Q
insulate Return
R
Refrigerator L.L. dryer
®
Conn. to exist. elect. �04
❑ &tt aF''r' °^,'r'^mart
10
Shroud
Eq Quality Control ❑ IAQ ( } ❑Qm=f � Reach
14 Home Service Plan { u91)
ADDITIONAL:
By; Date:
Terms: Cash ❑ Check„ ❑ CC
INSTALLED
AMOUNT:
REBATES
(mailed to home owner)
S TOTAL
r
By:
Gnmpnny Re prex�marive
S
S
� �kpoC)
Dater - 1- I
Exp. ❑ Financed through:
Note: Beginning 2010, R•22 equipment will no longer be produced Replacement parts and refrigerant will be available, however. equipment cannot be mixed. 410A is the new refrigerant.
BUYER'S RIGHT TO CANCEL. This is a home solicitation sale. and it you do not want the goods or serAces. you may cancel this agreement by providing written notice to the seller in
person, by telegram. or by mail. This notice must indicate that you do not want the goods or services and must be delivered or postmarked before midnight of the third business day after
you sign this agreement. If you cancel tttis agreement, the seller may not keep all or part of any cash down paymenL