HomeMy WebLinkAboutBuilding Permit Application Apr 241512:08p Jack Frost A/C of So Fla 772-336-9032 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 04/24/2015 Permit Number:
RECEIVED APR'-2 4.1015
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 XX
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 3784 Shadberry Court, Port St. Lucie,FL 34952
Legal Description: SAVANNA CLUB PLAT THREE BLK 24 LOT 77(OR 1619-2781)
Property Tax ID#: 3425-703-0200-0004 Lot No. 77
Site Plan Name: Block No. 24
Project Name: Jeny Johnson
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace alc equipment, like for like
Goodman 2.5 ton 14.0 SEER package unit,with 8kw heater
CONSTRUCTION INFORMATION:
AcIditional work toe e orme un ert ispermit—checka appy:
HVAC F]Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 3800.00 Utilities. Sewer E Septic Building Height:
O W N ERAESS EE: CONTRACTOR:
Name Jerry&Patricia Johnson Name: Jacques C.Stiegelman
Address: 3784 Shadbery Ct. Company: Jack Frost AC of South Florida,Inc.
City: port St.Lucie State:FL Address: 1716 SW Biltmore Street
Zip Code: 34952 Fax: City: Port St. Lucie State:FL
Phone No. (917) 664-2658 Zip Code: 34984 Fax: (772)336-9032
E-Mail: Phone No. .(772)336-9030
Fill in fee simple Title Holder on next page(if different E-Mail: jackfrostflorida@aol.com
from the Owner listed above) State or County License: State CAC18157251 Co.25113
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Apr 241512:O9p Jack Frost A/C ofSoFla 772-836-9032 p.3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name: Na me:
Address: Address:
City: State: City: State:
Zip; Phone: Zip:_Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x NotApplicable
Name: Name.
Address: Address:
City: City:
Zip: Phone: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application 15 hereby made to obtain a permit to do the work and installabon as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie CouA makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con, lict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult math your Horne 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 Qr rKording vour Notice of Commencement. A -A-
'
STATE VFLORIDA STATI rFFLORIDA St Lucie
COUNTY OF St Lucie COUNTY OF
The forgoing wasacknowleciggd before me The forgoing instrurnprit was acknowledged before me
Of M11Y4 2oLffJ by thisqq 20M-,
this
(Nam of person ackn Wle gi Name 0?person ac noW e gi
"a
Jignature of Notary Public-State of Florida Si�riature of Notary Public-State of Flori
Personally Known XX OR Produced Identification N/A Personally Known XX OR Produced Identification N/A
Type of Identification Produced KPJSTINk R.PAVVSVRS� Type of Identification Produced_
4" .Commission No. FF007935 (Seal)
Commission No. FF00793 r4MUNky PUBLIC
STATE OF FLORIDA INA R.PARSON
FEW7935 TAR
E)tpires 400117 STATE OF FLORJOA
Revised 07/15/2014 COM FF0079M
!WES 4&2,!ft I;r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA-nON SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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