HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
w� u _=
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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 776 MIDWAY RD.
Legal Description:
Property Tax ID #: 3403-233-0001-0009
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
LIKE FOR LIKE A/C CHANGEOUT 2.5 TON 14 SEER, AIR HANDLER IN ATTIC
Lot No.
Block No.
Haalilonal work Lo oe errormea under tnis permit — check all apply:
HVAC L _ Gas Tank DGas Piping _ Shutters Windows/Doors
0_ Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 3375 Utilities: Sewer ElSeptic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name MEDFIELD REALTY AND INVESTMENTS
Name: LOGAN WINN
Address: 7496 COMMERICAL CIR
Company: WOLF AIR CONDITIONING & HEATING INC
Address: 3785 OLEANDER AVE.
City: FT. PIERCE State: FL
Zip Code: 34982 Fax: 772-464-1127
Phone No. 772-464-8298
E -Mail: WOLFAIRCONDITION@BELLSOUTH.NET
City: FT_ PIERCE State:FL
Zip Code: 34951 Fax:
Phone No.772-461-0532
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CAC1813681
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: 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 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; your Notice of Commencement.
a
_s
of Owner/ Lessee/Agent Sig Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S � - COUNTY OF 5
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of -1h c.,-t—h 20L -(!e --by this ik day of '"��- '� , 20 I G- by
ame of person acknowledging) (Name o person acknowledging)
(Signature of Notary Public- State of Florida }
Personally Known Ll"" OR Produced identification
Type of Identification Produced
1/�11 r !
(Signature of Notary Public- State of Florida }
Personally Known --'OR Produced Identification
Type of Identification Produced
Commission No. „ E MARTIN Commission No.
/4'R.M .Natery Public -Sten of FlorMs
Revised 07/15/20 1 ' „f; ;; ;,.� My Comm. Expires Apr $. 2019
9orl W thouSh NattoiialWAy Assn.
---I MIKE MARTIN
Notary Public - 518te of
My Comm. Expires Apr 3.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS