HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: y`�� Permit Number: Ko I- 4:�S-71
RECEIVED
LW-01-4111
Building Permit Applicatio
APR 19 "012
Planning and Development Services ST. Lucie County, Permitting
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 IMPROVEMENT LOCATION:
Address: 0 3 CC'T i r L J- (p
Legal Description: I� IQIU f� �16�aLIAZ)une6 Two Jr)lt Ln" (o
Property Tax ID#: &x58q '" SOZ-OQQ( "-CC5CD` Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
IH .5 �S ec�-_r /O C I,t)
9
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit- ck all appy:
❑✓_HVAC Gas Tank F]Gas Piping Shutters a Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: //�� S Ft. of First Floor:
Cost of Construction: $ W3 Utilities:cn Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name n(L i Name: RICHARD LEVINSON
Address: I klr5il ti Ave Company: SERVICE AMERICA
City: Ir 1Ce Mn State:LJ, Address: 2755 NW 63RD CT
Zip Code: M5qo Fax: City: FT LAUDERDALE State:FL
Phone No.T?2 -Z 261- 5QGIZ 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
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
commUcing work or recording our Notice of Commencement.
f
` s
Signature of Owner/L Is
see ontractor as Agent for Owner Signature of Cont I
actor/License Holder
STATE OF FLOR A STATE OF FIL DA
COUNTY OF �(b nf'8 COUNTY OF bunclrd
The forgoing instrui ent w s acknowledge efore me The forgoing instrument as acknowledged before me
this A day of r l 20 by this � ' day of iI 20 le by
�'\Ckam\ RkOvA �c'ul�f�5rl
(Name of person acknowledging) (Name of person acknowledging)
(Signature of No Public-State of Florida ) (Signature of VAMry Public-State of Florida)
Personally Known Personally Known v a en i ica ion
Type of Identifica io d bie Jeffries Type of Identification P Debbie Jeffries
° � Notary Public-State of Florida
2 A& 0 Notary Public-State oFlorida
= N c CommGG70668
Commission No. - ommisJfs�pG70668 Commission No. ��
r P /7/2021
Expires 21712021 OFF Expire
FOF FSO
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS