HomeMy WebLinkAboutBuilding Permit Application Aub, 13, 2015 11 ;42AM No, 5225 P. 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Da
Building Permit Application RECEIVED
Planning and DevelopmentServices AUG 1 1015
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FC 34982
Phone.(772)462-1553 Fax:(772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Mechanical
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Address: 8928 Champions Way Port St Lucie, FL 34986
Legal Description: LAKES AT PGA VILLAGE(PB 43-32)BLK A LOT 49(OR 3580-2327)
Property Tax ID#: 3334-501-0083-000-2 Lot No,49
Site Plan Name: Stanley Palle{ko Block No A
Project Name: Stanley Palleiko
Setbacks Front Back: Right Side: Left Side:
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HVAC,Equipment Change Out; Make-Carrier; A/H Model: 17134CNP0601-00; C/U Model:
CA14NA06000A; 10 KW Heater 5-f-v�-7�
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ACI ional work toperformed uncler this perm) —c ec a appy:
HVAC Gas Tank Das Piping _Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator ❑Roof
Total Sq. Ft of Construction: 5 .Ft.of First Floor:
Cost of Construction:$ 5858.92 Utilities:-Sewer l:l Septic Building Height-
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Name Stanley Palleiko Name. Donald W O'Bryon
Address:8928 Champions Way Company: Preferred AC&Mechanical,Inc.
City: Port St Lucie State:FL Address: 1643 Donna Road
Zip Code. 34986 Fax: City: West Palm Beach State:FL
Phone No.772-577-6888 Zip Code: 33409 Fax: 561-478-0089
E-Mail:n/a Phone No. 561-689-1093
Fill in fee simple Title Holder on next page(If different E-Mail: tricla@preferredacmech.com
from the Owner listed above) State or County License: CAC1817665
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
Aug. 13. 2015 11 :42AM No, 5225 P. 3
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DESIGNER/ENGINEER: ;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:
1 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 Assoclatipn ru.les,;hylaws 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 t Record a Notice of Commencement may result in your paying twice for
improvementYrk
op8
rty. tice of Commencement must be recorded and posted on the jobsite
before the firact' n. If yo n end to obtain financing, consult lender gr ttorney before
eommencin r cordinOdwNcitice of Commencement.
_Signature of Ow r/Less gent Signature of Cont icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Palma—n COUNTY OF P.1.B..h
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_day of_ 20 `by this 2't' day of A"' 20 _by
Donald W 0'B -As Agent canald W
(Name of p son ac owledgi ) (Name of p s n ackno I dging)
0 I
(Si at a of atary Public-State of Florida) (Sig a Joftary Public-State of Florida)
Persona own z OR Produced Identification Person n x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. FFP115B7 (Seal) Commission No. i Fz�tsa� --(;eal
w`
T111GIA RADD
TAI&A PAM
MY COMMI$AION 4 FF 2.11697 s
Revised 07/15/2 OfFylf�t�gl duly k 2tl1si ��a,, g Banded hin,Nomauf�un r Und tLwatea
BeMda��ilu Nt�y�ul3V6lla�an4tll2ra
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW- REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS ._- _