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ALL APPLICABLEBLINFOOMUST BE COI I E ED FOR APPLICATION TO BE ACCEPTED �f] / (/
Date: J' 1 t ? p 1 266 Permit Number: �" " 6 - 00 1 l
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r ^5 2S lmU9 D?a tment
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
I
PROPOSED IMPROVEMENT LOCATION:
Address: LIU Ii Carl ( v
Legal Description: TND ZOX CLr÷`tr 1e. reerve- Tub ii CQ" (e i `nt
r� 1
Property Tax ID#: 3 Z7— (—00'4 --GOOF(p Lot No. ��
Site Plan Name: Block No.
Project Name: .
Setbacks Front Back: Right Side: Left Side: !
• DETAILED DESCRIPTION OF WORK:,,. . r .
65(0Ci CIC Cf iv CU- 3 I/z tcr7C I y-c3rer /0 rLU
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CONSTRUCTION INFORMATION: _
Additional� work to be ertormed under this permit—check all that apply:
I�!HVAC Gas Tank Gas Piping I I Shutters ElWindows/Doors
ElElectric ❑ Plumbing Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ /03Z Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: � /� CONTRACTOR:
Name L lef c r n? j g al rdin& Name: RICHARD LEVINSON
Address: CO 0 v Company: SERVICE AMERICA
City: 61.)/ l nyn/ic/ State:2(* Address: 2755 NW 63RD CT
Zip Code: 30107 31,
Fax: 470 (— /1/68 City: FT LAUDERDALE State:FL
Phone No. 1-/-7Q X345_ /9 0 S Zip Code: 33309 Fax: 954-977-3591 l
E-Mail: Phone No. 954-979-1100
Fill in fee simple Title Holder on next page(if different E-Mail: EPERMITSGROUP@SERVICEAMERICA.C;OM
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 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: 1
City: City:
Zip: Phone: Zip: Phone: 1
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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
commencing work or recording your Notice of Commencement.
s
Signature of Owri i'/iessee/Contractor as Agent for Owner Signature of Contra*to'r/ icense Holder
STATE OF FLORIDA STATE OF FLORI -
COUNTY OF (d COUNTY OF 'P7r13(..i Ire!
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 3t day of jr1 I ,•2011 by this.-jO day of ¶p'\\ ,20 l i by
(RichCIrd LL..1\ kr\sr\ kakCir-ta Le _, )"-Y--
(Name of person acknowledging) (Name of person acknowledging)
• / � :e5,:b667-7=M-------- --- ,
(Signa ure of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) I
Personally Known V 0• • ••- = - ion Per onally Known ✓ OR Produced Identif . ••••
Type of Identification Produce. A Kimeko AIIe+iAt T of Identification P od :,a•. . _
'� Notary Pu.+o F on�� P
ommission#GG75771 !z e;,� �0 Notary,PSubl'y�(-StateotlFlorida
Commission No. o� alJ✓ Co mission No.9, - . +- �� c: rri PSslbn#GG75771
9rFCFFL,•� Expires 2122!2021- 9r, We*�� Expires 2/22!2021
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Revised 07/15/2014
•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS