HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Q -��-1 jy Permit Number:
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 XX Residential xx
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 4200 North AIA, Bldg B, Unit #116
Legal Description: OCEAN HARBOR SOUTH BLDG B UNIT 116 AND UND INTEREST IN COMMON ELEMENTS
(OR 1341-2655-.1351-2507: 1664-1262)
Property Tax ID #: 1423-501-0104-000-9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace a/c equipment, like for like Goodman 2.5 ton 15 SEER w/ 5kw electric heat
CONSTRUCTION INFORMATION:
Additional work to be pertormed un er t is permit— c ec a y
app;
LJHVAC Gas Tank E]Gas Piping _ Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers I Generator ❑ Roof
Total Sq. Ft of Construction: 5Ft. of First Floor:
Cost of Construction: $ 3995.00 Utilities:cn Sewer E]Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Timothy McCarthy & Julia Maienza Name: Jacques C. Stiegelman
Address: 1424 Patricia St. Company: ,lack Frost AC of South Florida, Inc.
City: Kissimee State: FL Address: 1716 SW Biltmore St.
Zip Code: 34744 Fax: City: Port St. Lucie State: FL
Phone No. (407) 520-7950 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: JACKFROSTFLORIDA@AOL.COM
from the Owner listed above) State or County License: CAC 1815725 / 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 BOLDER: 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,tg work or recording your Notice of Commencement.
Signaturej6f Owner/ Ag7fit/ Lessee
Personally Known XX OR Produced Identification NIA
Type of Identification Produced
Commission No. FF007935 (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of U tractorTTLicense Holder
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STATE O LORIDA rL � 0 m tN
COUNT OF St_ Lucie D
LL LL
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gED
The for g instrum nt as acknowled a before me_a g €�- E .
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this � -rtay of Zp by O
Jacques G. Stie
(Name of person acknowledging }
` 'CiL�4U U yam'
(Si ature of Notary Public- State of Florida }
Personaliy Known XX OR Produced Identification N/A
Type of Identification Produced
Commission No. FF007935 (Seal)
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
CD
STATJF FLORIDA
Q Q
COU OF St. Lucie
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The fo g instru ent was acknowledged
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befog �� ® N
LL
this _-1 day of
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X 0 o amt
Jacques C. Stie e€man 0 W
(Name of person acknowledg' )
wit;"PI,
( gnature of Notary Public- State of
Florida )
Personally Known XX OR Produced Identification NIA
Type of Identification Produced
Commission No. FF007935 (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of U tractorTTLicense Holder
it .W Cg c
STATE O LORIDA rL � 0 m tN
COUNT OF St_ Lucie D
LL LL
�= cr UJ
gED
The for g instrum nt as acknowled a before me_a g €�- E .
�
this � -rtay of Zp by O
Jacques G. Stie
(Name of person acknowledging }
` 'CiL�4U U yam'
(Si ature of Notary Public- State of Florida }
Personaliy Known XX OR Produced Identification N/A
Type of Identification Produced
Commission No. FF007935 (Seal)
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
772-462-ISS3
FAX 772-462-IS78
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE: A1C change out permit application
Permit #
Credit Card Users: 1.5% Surcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
XXX VISA
MASTERCARD
Credit Card Number 4741 6599 9170 7737
Expiration Date 09119 Zip Code 34990
3 digit security code 580
Amount $ permitfee + 1.5% surcharge
Business Name: Jack tjost AO (A South Florida. Inc.
Authorized Signature:
Print Name:
Phone: (--L72 ) 336 - 9030
Fax: ( 779 33e .- grasp
Comments:
SLCPDSD Revised 4/01/2010 EN