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
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
P:ROROS ED]MP ROY EMENT'LOCATION
Address: 140 PEPPER LN
Legal Description: BAY TREE LOT 24 (OR 3446-1169)
Property Tax ID#: 4511-503-0030-000-4 Lot No. 24
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIO40FOORK:
CONSTR'UCTION' IN.FORMAThON.
Additional work toe e orme under this permit–check a appy:
✓❑—HVAC E] Gas Tank Gas Piping _Shutters a Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 6587 Utilities:[]Sewer Septic Building Height:
OWNERAESSEE: J=CONTRACI"OR:
Name Frederick W Hellthaler Lynda A Hellthaler Name: RICHARD LEVINSON
Address:140 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.914-500-5396 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.
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SUP,PLEMENTA`L:CONSTwRUCTION LftWIAW_IN'FORMATION.
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 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
improveme o your property.A Notice of Commencement be recorded and posted on the jobsite
before the I S.
i sp ction. If you intend to obtain financing, c nsu wi h lender or an attorney before
commencifngwhroWrecordingour Notice of Commenceme t
s
Signature o n essee/C tractor as Agent for Owner ure ontract /License Holder
STATEFLOR A ;OU
E OF FLORJDA
COUNTY OF If-o� � y"� NTY OF t`.Xt�c oclir�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this J'q.day of d_ 20 Eby this Jq day of - 20 11 by
9'1%c 1,.nV-C: '-k-_Q 11'1 `r if' r-A 1 ci i
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida j
Personally Knawn ro ucT eo 1 en iffis tion Personally Known o uce lIntif�cat��r��
Type of ldentifica i .Kime�0 Type of Identification P o a �'�� ime o
X_
0 a o ary a o ary Pi7�fic-stateeFF!
Commission No. N c Costimis 'PPn�a�11G� G75771 COS n#GG75771
r Ex irr so�72212021 Commission No. N �e 2W
fiot a p rF C o` Expire 2/22/2021
e �-
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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