HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 3 982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Mechanical
PROPOSED INPROVEMENT LOCATION:
Address:
Residential xx
Legal Description: 1K —(I ni 4 19
-
Property Tax ID #:I So 1 — LP 1 — C)1:54— Coo ='(.p Lot No. O� Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Replace a/c eauinmPnt like fnr Gka
Aaaitionai work to De pertormed
under this permit — chec
a apply:
HVAC Gas Tank
❑Gas Piping
1:1Shutters o Windows/Doors
Electric 0 Plumbing
LiSprinklers
I Generator 1:1 Roof
Total Sq. Ft of Construction:
S Ft. of First Floor:
,r���
Cost of Construction: $ 7 0 • CaU Utilities: -Sewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_P_ck
-e
Name: Jacques C. Stisgelman
Address; 10c)
Company: Jack Frost AC of South Florida, Inc.
City= e e,
State: FL
Address: 1716 SW Biltmore Street
Zip Code: [ Fax:
City: port St. Lucie State: FL
Phone No. O —3(
'-7
Zip Code: 34984 Fax: (772) 336-9032
E -Mail:
Phone No. (772) 338-9030
Fill in fee simple Title Holder on next
page ( if different
E -Mail: jackfrostflorida@aol.com
State or County License: State CAC1815725 /Co. 25113
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applica
Name: _
Address:
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name: _
Address:
City:
Zip;
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip; 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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cont lict 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
commeQ#ng worldoVecording your Notice of Commencement. A
SignrEOF
of Ownel% Agent/ Lessee
STA FLORIDA
COUNTY OF St. Lucie
The f ng instru t was acknowledged before me
thisay of 20 by
oac ues U. Stie el
(Name person acknowle gin J
I A Art M�1-1JG` �
(S g ature of Notary Public- State of Florida )
Personally Known XX OR Produced Identification N/A
Type of IdentKicatran'Produced
Signature of ntractor7License Holder
STATE O FLORIDA
COUNTY OF St. Lucie
The for $gi� instr°� nt was ?cknowledged before me
thisaayof 1 (+ILL` 20®by
Jacques C. Stie elman
(Name of p rson acknowledging )
. CI.iA
(Sig a ure of Notary Public- State of Florida )
Personally Known XX OR Produced Identification N/A
Type of Identification Produced
. .
Commission No. FF007935
}I &INA R. PARSONS
Commission No. FF007935
(Seal)
I y
NOTARY PUBLIC
'jwy
KRISTINA R. PARSONS
npinA4
NOTARY PUBLIC
Revised 07/15/2014
_ Comm# FF007935
�
4 STATE OF FLORIDA
E A Expires 4/2312017
+ycE
Comm# FF007935
ti9ti`�
—Expires 4/2312017
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED