HomeMy WebLinkAboutBuilding Permit Application 3 b�R 1
ALL APPLICABLE INFO//MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! �0�0�! / Permit Number:
k
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 X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMP,9OVEMENT1OCATION
Address: 123 PEPPER LN
Legal Description: BAY TREE LOT 11 (OR 1728-389)
Property Tax ID#: 4511-503-0017-000-7 Lot No. 11
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF WORK
CSTRUCTION INFORMATION
O'Nss
Additionalwork toe e orme under t —checkispermit a appy:
HVAC E]Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 6255 Utilities:Sewer Septic Building Height:
"OWNER/LESSEE:';. a "-CCONTRACTOR:
Name Patricia G Dawson Name: RICHARD LEVINSON
Address: 123 Pepper Ln Company: SERVICE AMERICA
City: Jensen Beach State:FL Address: 2755 NW 63RD CT
Zip Code: 34957 Fax: City: FT LAUDERDALE State:FL
Phone No.201-666-3801 Zip Code: 33309 Fax: 954-977-3591'
E-Mail: Phone No. 954-979-1100
Fill in fee simple Title Holder on next page(if different E-Mail: EPERMITSGROUP@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.
SUPPLEIVIENTAL^CONSTRUGTION LIEN{ LAW INFORMATIONS '
DESIGNER/ENGINEER: =Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEESIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 toour property. A Notice of Commencement must be recorded and posted on the jobsite
before 0fefi_-rqt inipection. If you intend to obtain financing, cwit lender or an attorney before
comm nci rk r recordingour Notice of Commencememta
• s
Sig as Agent for Owner Sign ontractor/L ense Holder
STATE FLO;;5e,,�/Contractor
ATE OF FLORIDA
COUNT OF pcyC)y COUNTY OF Y
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_L'% day of 0�-C& 20 OLby this day of 20 �_l by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known %in PIC 'uced Ide tion Personally Known L,_� OR Produced Identification
Type of Identificat o KimekoAllen Type of Identification Produce
= a Notary Public-State of Florida osP os� Kimeko Allen
Commission No.6 Comm isfgRjGG 75771 Commission No. GG 15—V) " )y Public-StateofFlori
:33;� Expires 2/22/2021 upl, c Cossi 771
2!2212021
Expires
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS