HomeMy WebLinkAboutBuilding Permit Application May 131510:39a Jack Frost A/C of So Fla 772-336-9032 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A), �� Permit Number: /�'" i L
RECEIVED
Building Permit Application MAY 13 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential XX
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 7602 Fort Walton Ave.
Legal Description: LAKEWOOD PARK-UNIT 6- BLK 67A LOT 4(MAP 13/02S)(OR 3674-1660)
Property Tax ID#: 1301-606-0203-000-0 Lot No. 4
Site Plan Name: Block No. 67A
Project Name: Mark&Karen Baker
Setbacks Front Back: Right Side: Left Side:
q���DESCRIPTION OF WORK:
i
Replace a/c equipment, like for like
Trane 2.5 ton, 14.5 SEER with 8kw electric heat
CONSTRUCTION INFORMATION:
Additional work to be oertormed under tis permit—c ec all appy:
HVAC Gas Tank FGas Piping _Shutters Q Windows/Doors
Electric Plumbing ❑Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq.Ft. of First Floor:
Cost of Construction:$ 4000.00 Utilities.11Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Mark&Karen Baker Name: Jacques C_Stiegelman
Address: 112 Linden Ave. Company: Jack Frost AC of South Florida, Inc.
City: Hanover State:PA Address: 1716 SW Biltmore Street
Zip Code: 17331 Fax: City: Port St. Lucie State:PA
Phone No. (814)418-4329 Zip Code: 34984 Fax: (772)336-9032
E-Mail: Phone No. (772)336-9D30
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 CAC1815725/Co.25113
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
May 131510:39a Jack Frost A/C of So Fla 772-336-9032 p.3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X Not Applicable
Name: Name:
Address: 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 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 pians,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 fist inspection. If you intend to obtain financing,consult with lender or an attorney before
commencin work or reco rd ing your Notice of Commencement.
Signature Owner/Ag nt/Lessee Signature orLOr,DA
actor/License Holder
STATE q�F FLORIDA STATE O
COON OF St. Lucie COUNTY OF St. Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this +day of )raq , 20by this
-APkiay of 201a)by
Jacques C. Stiegelman Jacques C.Stiegelman
(Name of person acknowl dginE I (Name of rson acknowledging) �1
• UVWV/vim
(5ig ature of Notary Public-State of Florida) SSig, ture of Notary Public-State of Florida)
Personally Known XX OR Prockff#AJWt2fii' 45NIA Personally Known XX OR Produced Identification NIA
Type of Identification ProPUBLIC Type of Identification Produced RSOF
In—Ipi of FL ARY PUBLIC
Commission No. FF p07g35 Commission No. FF007935 ATE OF FLORIDA
cam
1EVW04123)20'7 Comm#FF007935
Eonas 4124 17
Revised 47/15/2014
I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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