HomeMy WebLinkAboutBuilding Permit Application Jul 271511:G3a Jack Frost A/C ofSoFla 772-336-9032 p2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO 8E ACCEPTED
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Date:- -7 1,.1-1 RECEIVE Permit Number:
JUL 2 7 2015
Building Permit Application
P)anning and Development Services tiltti
Bufiding and Code Regalation Division
2300 trirginia Avenue,Fort Pierre FL 34982
Phone:(772)462-ISS3 Faxt(772)462-1578 Commercial Residential XXX
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back:_Right Side: Left Side:
D�fNILEDDESCRIPTION OF WORK:
Replace a/c equipment, like for like 7 ':�T
CONSTRucribN INFORMATION:
Additional work to be performed under this permit—c eck al apply:
Total Sq-Ft of Construction: 1�4- Sq.Ft.of First Floor:
Cost of Construction:$ Utilities:0 Sewer F Se-ptic Building Height:
OWNER/LESSEE: CONTRACTOR,
-Name Name: Jacques C.Stiegelman
Address: '%-Vtf- Ask,;� --AGLCLc-i- Company: Jack Frost AC of South Florida, Inc.
City: State: FIL Address: 1716 SW Biltmore St.
City: Port St.Lucle State: FL
Zip Code: Fax;
Phone No. 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.Mafi: jsckfrostflorida@�aof.mm
from the Owner listed above) State or County License: Slate CAG1815725 I Co.25113
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required,
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Jul 271511:53a 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:
Add ress: 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 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.
t I
Signatutd oo Owner/Agent/Lessee Signature ;rL(OIRIDA
ractor/Licen er
STATEF FLORIDA STATE O
COUNTY OF St.Lucie COUNTY OF St.Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this��day of 2 OL--
J by this.2]_day of 20 y
Jacques C.Stiegelman Jacques C. Stiegelman
(Name of person acknowledgin ) (Name cknowledgin )
i
,� G�UJOJ� - Glil�JGl'�
( i nature of Notary Public-State of Florida) (Sign ture of Notary Public-State of Florida j
Personally Known XX OR Produced Identification N/A Personally Known XX OR Produced Identification NIA
Type of Identification Produced Type of Identification Produced
ISTINA R_PARSON
Commission No. FF007935 6FR ,.r5PUBkic Commission No. FF007935
S ("RRIS-nNA R.PARSON
-•gTATE OF FLORIDA NOTARY PUBI.I
Revised 07/15/2014 9t►� Exp1re54123f2017 Correm*FFOo 93FLORIDA
.`yCE 1910 EXP1reS 412
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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