HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: lolmh4v 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 Residential XX
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 7965 Saddlebrook Drive, Port St. Lucie
Legal Description: SABAL CREEK-PHASE IV- LOT 166 (OR 1708-66)
Property Tax ID #: 3328-701-0019-000-4 Lot No. 166
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace master bedroom a/c equipment, like for like
Rheem 2.5 ton 16 SEER with 5kw electric heat
CONSTRUCTION INFORMATION:
itiona wor to e e ormed under tispermit—check all appy:
HVAC Gas Tank EGas Piping _ Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: S�Ft,] of First Floor:
Cost of Construction: $ 4000.00 Utilities: Sewer D Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Debra Morris Name: Jacques C. Stiegelman
Address 7965 Saddlebrook Dr Company: Jack Frost AC of South Florida, Inc.
City: Port St. Lucie State: FL Address: 1716 SW Biltmore St.
Zip Code: 34986 Fax: City: Port St. Lucie State: FL
Phone No. 772-971-0603 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 F-Mail: JACKFROSTFLORIDA@AOL.COM
from the Owner listed above) State or County License: CAC1815725 / 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
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x Not Applicable
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
commenciAig work or recording your Notice of Commencement.
Signature Owner/ Agit/ Lessee Signature of
STAT F FLORIDA STATE O,
COLI OF St. Lucie COUNTY'[
tractor/License Holder
IDA
St. Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this f�`4tiay of &C� , 20by this /%qday of 0C+Abe - , 20=by
Jacques O. Stiegelman Jac ues C. Stie elman
(Name of person acknowled 'ng } (Name of p son acknowledgi )
ignature of Notary Public- State of Florida) (Sign re of Notary Public- State of Florida }
Personally Known XX OR Produced Identification N/A Personally Known XX OR Produced Identification N/A
Type of Identification Produce KRISTINA R. PARSONS Type of Identification Prod u ced—o0kyA..KRISTI
NOTARY
Commission No. FF00793 PMT)E OF FLORIDA Commission No. FF007935 NOTARY P[ BLIC LORI
-�E OF FLORIDA
Comm# FF0{)7$35 Comm# FF0079A
v�1i �7S
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED