HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
tF L 4 R l D R....
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34482
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential xxx
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:��
Property Tax ID #: L4 5 l 1 —.50 --- (3 0 0` 1 _0 [ - _g
Site Plan Name:
Lot No.
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace a/c equipment, like for like-� �r C Yl i I~p
; rj "(,r'1
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit '-check all apply:
HVAC 13 Gas Tank OGas Piping
Shutters
Electric FlPlumbing I
Windows/Doors
F]
Sprinklers Generator
Roof
Total Sq. Ft of Construction: 5 . Ft. of First Floor:
Cost of Construction: $ ')-(o--7
_0c)Utilities:oSewer Septic
Building Height:
OWNER/LESSEE:
Name('-�nf
Address:) C)Pl 2� _,r (" [_ 'a+C1 _
City: )qn , PXi l -t"A( �'� State: FL
Zip Code: -1 �l 7I Fax:
Phone No.
E -Mail:
Fill in fee simple Title Halder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: Jacques C. Stiegelman
Company: pack Frost AC of South Florida, Inc.
Address: 1716 SW Biltmore St.
City: Port St. Lucie State: FL
Zip Code: 84984 Fax: (772) 336-9032
Phone No. (772) 336-9030
E -Mail: jackfrostflorida@aol.com
State or County License. State CAC1815725 / Co. 25913
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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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
commenci work or recording your Notice of Commencement.
Signature caner/ Agent/ Lessee Signature of ctor/Lice a Holder
STATE 0 FLORIDA STATE OF LORIDA
COUNTY OF St_ Lucie COUNTY OF St. Lucie
The forgoing instrument waJk �^cknowI d ed before me The forgoing instrument was acknowledged before me
this S day of t_ -i I 20 ,] by this P day of M(jXJ ('kl 20EIby
Jacques C. Stieqelman
(Name f person acknowledge )
a r�
gnature of Notary Public- State of Florida )
Jacques C. Stieqelman
(Name of person acknowledging
/I,/A
(S� ature 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 Produced a of Identification Produced
KIR ft. ids
Commission No. FF007935VEA
NOTARY PUBLIC Commission No. FF007935 Y KRISTINA R. PAZONS
8TATE OF FLORI NOTARY PILIBLI�
FF007935 ' STATE OF FLOE e 7A
Comte �
Expires 4r/�i261 tis $ mm# FEIe
Revised 07/15/2014 Expires 4/23/20 a
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE I MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED