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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application Planning and Development Services i Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X PERMIT APPLICATION FOR: Mechanical i PROPOSED IIVIPRQV,EIVIENT LOCATION .4y , Address: 5912 TRAVELERS WAY Legal Description: PALM GROVE S/D BLK D LOT 20 (0.12 AC)(OR 1765-2959; 3217-813), Property Tax ID#: 3410-503-0116-000-8 Lot No.20 Site Plan Name: Block No. D Project Name: I Setbacks Front Back: Right Side: Left Side:' ETAILED Db I'P_ TION OF WO DRKr v rt U , G: . s :J cQ .,:5 /0/J-5 :C S zee SIZE zA 6 `i CONSTRUCTION INFORMATION Additionalwor to e f performed under tis permit—c ec all appy: ❑✓_HVAC Gas Tank []Gas Piping _Shutters ❑Win;dows/Doors li ❑Electric ❑ Plumbing ❑Sprinklers 0 Generator ❑ Roof Roof pitch Total Sq. Ft of Construction: p� SFt. of First Floor: Cost of Construction:$ [�-�©(J '�� Utilities:cn Sewer❑Septic Building Height: OWNER/LESSEE CONTRACTOR i �, R, ! - Name Mary L Janco Name: Richard Levinson Address:5912 Travelers Way Company: Service America City: Fort Pierce State:FL Address: 2755 NW 63rd Ct Zip Code: 34982 Fax: City: Ft Lauderdale, State:FL Phone No.772468-4664 Zip Code: 33309 Fax: 954- E-Mail: Phone No. 954-979-1100 EXT 5673 Fill in fee simple Title Holder on next page(if different E-Mail: EPERMITS,GROUP@SERVICEAMERICA.COM from the Owner listed above) State or County License: CAC014619 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. i �., SUPPLEMENTAL CONSTRUCTION LIENtLAV1/ INFORMATION E, =W-A' DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: i 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 thepermit 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 improve,ments to your property. A Notice of Commencement mu a co ded and posted on the jobsite before I t i pection. If you intend to obtain financing, con ult it le der or an attorney before comm ncln or or recordingour Notice of Commencement. I ' s Signature,o se Contractor as Agent for Owner Signature of Co kens Holder STATE OF FLORIDA STAT OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this A day of 5 20 nby this Imo,day of 20 ]Z by 9-1 t0110 V-A- ��y[112 � ► (� ��c9y I v'l (Name of person acknowledging) (Name of person acknowledging) v � O (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known_�OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No. _ ea Commission No, CTS c (S Kiiiieko Allen o �'9 Kim Allen a e !& 0 Notary Public-State of Florida T f�� Notary Public-State of Florida v e Commission#GG75771 �� �� Commission Revised 07/15/ 0' "r=F� Expires 2;22/2021 �; r`o�� Explres 212212021 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS