HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED L_�5 _
Date: 9 S Permit Number:
\ RECEIVED- t
Building Permit Application SEP 2 9 2015
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 XXX
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 0o S. ocaw Dr
Legal Description: —
::t NJ C'nnnMd n� PmPrC-S ( off - f gW - a S 13,a af)-104x)
Property Tax ID#: -15o Cit oa l q —ow 4_0 Lot No.
Site Plan Name: Block No.
Project Name:'.� �Q uo ►,s
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace a/c equipment, like for like - '-e lQC e- W►-'1 I-ra- 1 e. -Ton 1 y5fck
CONSTRUCTION INFORMATION:
Additional work toe nertormed under tispermit-check all that appy:
HVAC Gas Tank E]Gas Piping 11 Shutters ]Windows/Doors
11 Electric 0 Plumbing Sprinklers E Generator FIRoof
Total Sq.Ft of Construction:II ,^, S Ft.of First Floor:
Cost of Construction:$ ,�l�UQ ,CSO Utilities:nSewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ar a L0Ue Name: Jacques C.Stiegelman
Address: o? Company: Jack Frost AC of South Florida, Inc.
City: L&Elsen Qeac:_ State: FL Address: 1716 SW Biltmore St.
Zip Code: s7 Fax: City: Port St. Lucie State: FL
Phone No. '7 a - DO 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-Mail: lackfrostflorida@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.
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 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
commencft work qA rwording your Notice of Commencement.
/k1 -
Signatur of wrier/Agent/Lessee Signature of actor/License Holder
STATE FLORIDA STATE FLORIDA
COON OF St. Lucie COUNTY OF St. Lucie
The for oing instru pentwas ack owl ed before me The forgoing instrument was acknowledged before me
this day of 20 f�by this day of 20®by
Jacques C. Stiegelman Jacques C. Stiegelman
(Name of person acknowledgin (Name f person acknowledgi
(Siihature of Notary Public-State of Florida) (Si nature of Notary Public-State of Florida)
Personally Known XX OR Produced Identification N/A Personally Known XX OR Produced Identification N/A
Type of Identification ProducedO Type of Identification Produced
KKI�III AR-PA
Y OTARY PUBLIC ft,1RJ�121STINA R.PARSOCommission No: FF007935 : � N Commission No. FF007935 ((��- TATE OF FLORID TARY PUBLIC
Comm#FF007935 STATE OF FLORIDA
-dVCE 1j% Expires 4/23120111"
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Revised 07/15/2014 Exp'es 4/23/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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