HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� Jq
Date: Permit Number: I ' 004 I
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ROOM-
Building
Permit Application
Planning and Development Services
Building and Code Regulation Division j
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
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PROPO'SED.',`[ PRO`VEIVIE;NT;LOCATION ;`Fa .
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Address: 13452 HARBOUR RIDGE BLVD 2A
Legal Description: PALMETTO VILLAGE BUILDING 4 UNIT 2A(OR 602-2100: 1168-1574),;
Property Tax ID#: 4436-605-0026-000-6 ! Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:,
DETAILEb DESCRIPTION 40F WORK
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txcici AC_ Ciorne. IOU+ Efions i4Gc r 0 EWK
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,CONSTRUCTION IN'FORMATIOIV d , _,} ° k
Additionalwork to be nertorme un er this permit–c ec a appy:
✓❑_HVAC Gas Tank OGas Piping _Shutters Q Windows/Doors
0 Electric ❑_Plumbing Sprinklers 1:1 Generator E] Roof Roof pitch
Sq. $4299 '
Total S Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ Utilities. —Sewer Septic Building Height:
I OV1/N'ER%LESSEE CONTR'ACTOR`, f"
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Name Kristin H Dusterberg Name: RICHARD LEVINSON
Address:8800 Sandymar Dr Company: SERVICE AMERICA
City: Cincinnati State:FL Address: 2755 NW 63RD CT
Zip Code: 45242 Fax: City: FT LAUDERDALE I State:FL
Phone No.772-336-7541 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: EPERMITSGROUF@SERVICEAMERICA.COM
from the owner listed above) State or County License: CAC014619
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SU,PPCEIVIENTAL CO'NSTR,UCTION LIEN LAW' INFORMATION
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: I
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:
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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. -you intend to obtain financing, consult with fender or an attorney before
commp,ncing work or_rec6rcling your Notice of Commencement.
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Sig-nature-df ner/Lessee/Contractor as Agent for Owner Sign of Contractor/License Holder
STATE OF FLO IDA STATE OF FLORIDA -II
COUNTY OF d'Du,Qa r(� COUNTY OF 10fOLOO( i
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this-31 day of be (L 20 VT by this day of �2R,; 20 Lj- by
Q\%CyXwA Lei n�v�rl �c�Q�d Lev 1,nsorl
(Name of person acknowledging) (Name of person acknowledging)
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(Signature o Public-S (Signature of ry Public-State of Florida)
ftY P(, Rb[Qd9fiR0JPl`Q
bie Jeffries y PG
Personall P n e�� ✓8dA* ation Personally o1PN&&Wf�tifica on
Type of I if io ro u 668 Type of Ide cal®n F�QIPublic Slate of Florida
o o` Commission
Commissi n OFFS° Expires 21712021 Commissio 9 0�� Expires217120(K4eal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION !I SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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