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_ ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (R\9\\cb Permit Number:Aq Gi (563
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Building Permit Application
Planning and Development Services UG018Building and Code Regulation Division2300 Virginia Avenue,Fort Pierce FL 34982STie � rmlrting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resl X
PERMIT APPLICATION FOR: Mechanical
PROPOSED`CMP.ROVEME'NT'LOCATION: '
Address:I?Gc� UAY11 W b�S LDnQ)
Legal Description:1EQ e)1$ XX (SONIMC.U1 WO 9 A2-2,A) BM_ 5fo
LOT ") (M Z\'9U 72db)
Property Tax ID#: 3112A- 1 OI - 0095A —000 (o Lot No.
Site Plan Name: 8&01".) Block No.50
Project Name: TWJ`�
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION`OF'WORK.�
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02 Ut r,)ITS "q:S
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EONSTRUCTfON INFORMATION
_
Additionalwork toe nertormed under tis permit—checlln appy:
HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: a SFt.of First Floor:
Cost of Construction:$ q�J� 1 Utilities:n Sewer O Septic Building Height:
OWN ER/LESSEE' `CONTRACTCiR:
Name �--: �� Name: RICHARD LEVINSON
Address: WV%iWJ %bi& uA Company: SERVICE AMERICA
City:VOCIV ish-WU1Q., State:EN. Address: 2755 NW 63RD CT
Zip Code:3ACVb2 Fax: City: FT LAUDERDALE State:FL
Phone No. (003- 3(0\. 9-.412. 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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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.
s
Signature of Own r/Lessee/Contractor as Agent for Owner Signature of Cont"t,ctor/License Holder
STATE OF FLORID _ r STATE OF FLORIDA'— 7 P
COUNTY OF p��"' COUNTY OF /0�, rC
The fpr g instr ent a owledged before me The fo ing instr ent w'asta wledged before me
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this / day of 20 by this day of l/Iv 20 /9 by
(Na of person a k led ' me o erson now
:aaY Pie Sheneke Hardy
o �, Sheneka Hardy
Notary Public-State of FI rida =
` ® NotaryPublic-StateofFlorida
n c Commission#GG338 rr--P146ieR#GG 33870
(Signa re o ota PublI - t `ida) xpires ( natur of�Ii `. rid6pires 927/2020ersonally �OR Produced Identification Personally n Identification
Type of Identification Produced 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