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, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 5901 Cassia Drive, Ft. Pierce
Commercial Residential xx
Legal Description: INDIAN RIVER ESTATES -UNIT -09- BLK 78 LOTS 38 AND 39 (MAP 34/12S)(OR 1670-2717)
Property Tax ID #: 3402-610-0263-000-7
Site Plan Name:
Project Name:
Setbacks Front Back:
� DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Lot No. 38 & 39
Block No. 78
Replace existing a/c equipment, like for like, with Rheem 3.0 ton 16 SEER equipment with 7.5kw
heat.
A00ititional worts to be rtormed under this permit — check all that apply: HVAC ILII Gas Tank []Gas Piping ILII Shutters a Windows/Doors
11 Electric ❑ Plumbing Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: S. of First Floor:
Cost of Construction: $ 3950.00 Utilities:,nSewer D Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name Colleen Flaherty
Name: Jacques C. Stiegelman
Address: 5901 Cassia Drive
Company: Jack Frost AC of South Florida, Inc.
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No. (772) 634-3088
Address: 1716 SW Biltmore St.
City: Port St. Lucie State: FL
zip Code: 34984 Fax: (772) 336-9032
Phone No. (772) 336-9030
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: JACKFROSTFLORIDA@AOL.COM
State or County License: CAC1815725 I Co. 25113
1 vo,uq u! LVID tU ucuuI9 173.?c3uu or more, a KtLUKutu ivotice oT 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 HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Mame: 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 b recorded and posted on the jobsite
before first inspection. If you intend to obtain financing, consul 1, ith lender or an attorney before
comm n .
4ing work//f r rgcording your Notice of Commencement. „
of Owner/',Agent/ Lessee
STATE OF FLORIDA
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COUNTY OF St. Lucie
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The forgoing instrument was acknowled ed befog
this � day of 20�
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by o' Q M
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The forgoing instrument was acknowledged beforZte
this � day
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Jacques C. Stie elman_
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(Name of person acknowledginZ
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Jacques C. Stie elman
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{Name of person acknowledgi�
(Siglla ure of Notary Public- State of Florida J
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Personally Known XX OR Produced Identification
N/A
Type of Identification Produced
Commission No. FF007935 (Seal)
Revised 07/15/2014
REVIEWSI FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signatur,,"pflsontractor/License Holder
M
STATE OF FLORIDA
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� U M 0-- -- �a
COUNTY OF St. Lucie
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The forgoing instrument was acknowledged beforZte
this � day
m
v3
of
20M by
I^ E
ZWULU
Jacques C. Stie elman
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{Name of person acknowledgi�
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"v my
(SiOature of Notary Public- State of Florida )
Personally Known XX OR Produced Identification NIA
Type of Identification Produced
Commission No. FF007935 (Seal)
SUPIIIVIIREVIEWOR RP
W V EV EW ON S REVIEW
MEV EWVE
" BUILDING & CODE REGULATION DIVISION
J`ifjj= 2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE: A/C 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 09/10 Zip Code 34990
3 digit security code 580
Amount $ permit fee ._.. + 1.5% surcharge
Business Name: .tack Frott AC Of mouth Florida, Inc.
Authorized Signature:
Print Name:
Phone: (—Z72 ) 336 - 9030
Fax: (..._ZZ22) 336 - 9032 r
Comments:
SLCPDSD Revised 4/01/2010 EN