HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5>� 11
Permit Number:J J1 J11
•
LRECEIVED I
Building Permit Application
Planning and Development Services 4 2018
Building and Code Regulation Division2300 Virginia Avenue, Fort Pierce FL 34982 nty, permittingPhone: (772) 462-1553 Fax: (772) 462-1578 Commercial Res
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 10125 Crosby PI
Legal Description: POD 26 AT THE RESERVE REPLAT CYPRESS POINT (PB 40-3) LOT 115 (OR 1737-2461)
Property Tax ID#: 3327-710-0017-000-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be nertormed under tis permit—check all appy:
✓❑_ HVAC Gas Tank I]Gas Piping Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers 7 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 4083 Utilities:Sewer E Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Tahseen Izhar Fauzia Hussain Name: RICHARD LEVINSON
Address: 10125 Crosby PI Company: SERVICE AMERICA
City: Port St Lucie State:FL Address: 2755 NW 63RD CT
Zip Code: 34986 Fax: City: FT LAUDERDALE State: FL
Phone No. 772-370-0762 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
commencing work or recording our Notice of Commencement.
I
!
Signature of Owne Lessee/Contractor as Agent for Owner Signature of Con ractor/License Holder
STATE OF FLORIDA�j f STATE OF FLORIDA6 _/
COUNTY OF Lpf 0Cl",c f COUNTY OF VywQr
The
forgoingd before me The forgoing instr en as a knowledged before me
this by this a day of ��' 20 L>�by
RICH ( RD LEVI S N
(Name erso ac w ene aHardy a e of pers ack
® Notary Public-State of Flor da a e� Sheneka Hardy
r.
Commission#GG 3387 ` Notary Public-State ofFlori,.;:.
c � ,�
Expires 9/27/2020 r� �c Commission#GG 3387,
nature o Nota Public State of Florida) re�otauof FlonPersonally Known OR Produced Identification P nallduced Identification
Type of Identification roduced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS