HomeMy WebLinkAboutBuilding Permit Application May 151512:39p Jack Frost AC 7723369032 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED )
Date: �� !e�' J Permit Number:
v
Building Permit Application
RECEIVED
Planning and Development Services �A� 15 1015
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 INPROVEMENT LOCATION:
Address: 3114 Columbrina Circle, Port St.Lucie,34952
Legal Description: SAVANNA CLUB-PLAT TWO-BLK 14 LOT 7(OR 3011-2361;3593-2637)
Property Tax ID#: 3425-702-0119-000-6 Lot No. 07
Site Plan Name: Block No. 14
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace a/c equipment, like for like
Rheem 4.0 ton package unit 14.0 SEER with 7kw heater
Model 9 RSPM-A48JK
[CONSTRUCTION INFORMATION:
Additional work toe perrormed under this permit—check all that apply:
HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric El Plumbing Sprinklers I Generator 1:1 Roof
Total Sq.Ft of Construction: S Ft,of First Floor:
Cost of Construction:$ 3600.00 Utilities:Sewer septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Doris E Berkley(LF EST),Lisa Draughon,Scot Clay Name: Jacques C.Sliegelman
Address:3114 Columbrina Circle 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. (772)626-2269 Zip Code: 34984 Fax: (772)336-9032
j E-Mail: Phone No. (772)336-9030
Fill in fee simple Title Holder on next page(if different E-Mail: jackfrostflodda@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 151512:39p Jack Frost AC 7723369032 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.
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 thepermit holderto 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 wi lender or an attorney before
comme ing work-or recording our Notice of Commencement.
I
SignZOF
of Owner/Agent/Lessee Signature of C tractor/License Holder
STA FLORIDA STATE OF LORIDA
COUNTY OF St. Lucie COUNTY OF St. Lucie
The forgoing instru ent was acknowledged before me The for oing instrL m�ent was acknowledged before me
this�day of 20=by this 'Nay of 1" Q7 j ,201M by
7
Jacques C.Stiegelman Jacques C. Stiegelman
(Name o person acknowledge ) (Name of person acknowledging
CLf.O Q.f.O
( ature of Notary Public-State of Florida) ( nature of Notary Public-State of Florida}
Personally Known XX OR Produced Identification N/A Personally Known XX OR Produced Identification NIA
Type of Identification Produced a R pARSO qtype of Identification Produced
A"
r KRISTINA R.P
OTARY PUBLIC PARn:
Commission No. FF007935 OTA pPUBLICFLORIDA Commission No. FF007935 NOTARY PUBLIC
Comm#$*007935 STATE OF FLORI
Comet#
Revised 0711512014 Expires 412312017 ' is . Expires 4/23/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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