HomeMy WebLinkAboutBuilding Permit Application So
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 09/10/2015 Permit Number:
RECER z SEP 10101
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 xxxx
PERMIT APPLICATION FOR: Mechanical
PRtJPOSEDyI ,r P,�RQVEMENT LOCA
,,r/,...ti� a, „ �� �
Address: 9121 short chip circle
Legal Description: LAKES AT PGA VILLAGE(PB 43-32)BLK D LOT 17 (OR 3550-619)
Property Tax ID#: 3334-501-0155-000-4 Lot No.
Site Plan Name: Block No.
Project Name: AIR CONDITIONING REPLACEMENT
Setbacks Front Back: Right Side: Left Side:
o ;,i,., /,, /�.. ��%��.;i,..,:„,,,,/,/iii /iij .,/,„,r✓/� r//,' , ..r��� ./... ,C� / �/ ,i/o;,:
REPLACE AIR CONDITIONING. CARRIER 15 SEER HEAT PUMP 10 KW HEAT 0 Ir1c h
CONSTRUCT %)NFQRNATCON r i,,/ ,,
Additional work to e e orme un er t is permit—check a appy:
❑✓ HVAC Gas Tank ❑Gas Pi _ Windows/Doors
11 Piping Shutters ❑
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 4000 Utilities:[]Sewer 0Septic Building Height:
QV1fNE'R/1_ESS, r r CQNTRAG' �R AC DQGTQRS INC%/
/O%/////i,„__�,., ,.,..
Name -:13 C Name: DAVDI KRUSE
Address: a1 \ Sino r C h'N]p C i r Company: A/C DOCTORS INC
City: Stater L— Address: PO BOX 1527
Zip Code: ��� Fax: City: JENSEN BEACH State-FL
Phone No. Zip Code: 34958 Fax: 7726075700
E-Mail: Phone No. 7726264629
Fill in fee simple Title Holder on next page(if different E-Mail: A/C DOCTORS INC
from the Owner listed above) State or County License: CAC058461
If value of construction is$2500 or more,a RECORDED.Notice•of Commencement is required.
ai
5�
cr! �! o/0%i ric •,5,,ir;,..;ro//,ori.,%;�1P U�EMEfNT���.CONSTRUCT"{ON LC�{�{'LAW {i���RMATiON�/'/ ,/i ,,
.... ,. .,.....,,.. .� ,moi,.- ...;
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:
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 thepermit 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 inspect n. If you intend to obtain financing, consult with lender an attorney before
commencing work or rdcordipg your Notice of Commencement.
Of
N N Q p 0 .Cy
N.
0 iy N
N Si nature ontrac icense Holder r
Li ture of Own essee/Agent g Cn W z
3w
-'SST OF FLORIDA STATE OF FLORIDA
--MV TY OF {ylG 1(111'1 COUNTY OF Maui (r)
H y & ~ h
V7 H o y d
Yg rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me $ o
CJ
ohm day of'5--Rr=(")oer 206 ,by this ►day of S{T("&h r,20 byco
z
�vtc IiiYUS-c David [�Yus-e
°. of person acknowledging) (Name of person acknowledging) ;Y°H• P�;�
(L1, � U MI Q1 A4
(Signature of Notary Public-State of Florida (Signature of Notary Public-State orida)
Personally Known OR Produced Identification I_�— Personally Known OR Produced Identification FL
.Type of Identification Produced k 602-0•I-tcifD•OLlci'O Type of Identification Producedle-wo'I a-6
Commission Nod 613i-l2ZZ (Seal) Commission NoEI� 13LI17 (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION • SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE -
INITIALS