HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
J -
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
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVEMENT LOCATION:
Address -
Legal Description:,��(
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Commercial
e 14D1l!
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace a/c equipment, like for like
A_
CONSTRUCTION INFORMATION:
❑itiona wor to �er orme un er t +s permit –c ec a71
�j HVAC _ Gas Tank Gas Piping L-1 Shutters
L lElectric ❑ Plumbing Sprinklers In Generator
Total Sq. Ft of Construction:
Cost of Construction: $�
OWNER/LESSEE:
Residential xx
Sq. Ft. of First Floor: _
Utilities: Sewer septic
Name Y it x,211 -
Address:_j'j"1UT )��=
City: ", Qin State: FL
Zip Code: Fax:
Phone No-t–Oq ___170
I J
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Lot No._
Block No.
QWindows/Doors
Roof
Building Height:
CONTRACTOR:
Name: Jacques C. Stiegelman
_ Company: Jack Frost AC of South Florida, Inc.
Address: 1716 SW Biltmore Street
City: Port St. Lucie State: FL
Zip Code: 34984 Fax: (772) 336-9032
Phone No. (772) 336-9030
E -Mail: jackfrostflorida@aol.com
State or County License: __ State CAC1815725 I Co. 25113
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY:
Name: Name:
Address: Address:
City_ State: City:
Zip: Phone: Z;
FEE SIMPLE TITLE HOLDER:.
Name.
Address:
City:
Zip: Phone:
x Not Applicable
►H Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I Not Applicable
State:
x Not Applicable
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, 1 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 t e first inspection. If you intend to obtain financing, consultith lend�r,pr an attorney before
comm9fiting wor oorecording your Notice of Commencement.
Sgnat of Owner/Agent/ Lessee Signature of tractor icense Holder
STA OF FLORIDA STATE LORIDA
COUNTY OF St. Lucie COUNTY OF St, Lucie
The f r g insTpw�!
ed ed before me
thisMay of 20M by
Jacques C. Stiegi
(Name op person acknowle&i
uA :Z -'--f 'at/j ow,
ature of Notary Public- State of Florida )
Personally Known XX OR Produced Identification NIA
Type of Identification Produced
The fpr7e*g instru P=7'
ledge�, before me
thi -tfay of V 20 by
Jacques C. Stie
(Name of erson acknowledgigg )
I &I-00
of Notary Public- State of Florida )
Personally Known XX OR Produced Identification N/A
Type of Identification Produced
Commission No. FF007935 �R� I TINA R. PARSONS Commission No. FF007935
F
RY PUBLICATE OF FLORIDA
m
Rev€sed 0711512014'% F 101 � Fxpires 4!2312017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED
ASTINA R. PARSC
AR t' PUBLIC
STATE OF FLORIDA
ExplreS 4123/20/7
SEA TURTLE f MANGROVE
REVIEW REVIEW