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'ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO B ACCEPTED
Date: Permit Number:
Building Permit Ap lication
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
PROPOSED IMPROVEMENT LOCATION:
Address: QA,;1 S. 0=0 M. Ak L06
TOM5M MOO-) 3`1QI5_I
Legal Description: SCJ 3(o -A\ U AN 'LNT C �W C L WAA Y�,Wl N 1—k fk\f.
1}Q 9)Z DEC ► 31 MkN 2PA SZG VI M-E .EC UA 23aC1i K 'T\AtA 0
Property Tax ID.#: ISV016CJ -33A- 000;�_> -22-0 "1 Lot No.
Site Plan Name: „((����nn,,tt4Block No.
Project Name: G�Ca` M
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF'WORK:
AIC GW V03t 21o5
TONS �SeDJV-
: ,CONSTRUCTION INFORMATION:. . `
Additional work to be nertormed under this permit-check all tha appy:
❑✓—HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
ElElectric ❑ Plumbing Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.o First Floor:
'5
Cost of Construction:$ 12.x, Utilities:,n S ewer Septic Building Height:
01NNER/LESSEE CON TRACTOR::.. 1
Name _ Name: RICHARD LEVINSON
Address: (AA31 8 o =L� 50- caG Comp ny: SERVICE AMERICA
City: I-O” 2Jab1 \ State:- Addre s: 2755 NW 63RD CT
Zip Code: ` iWb'l ' Fax: City: FT LAUDERDALE State:FL
Phone No.:-112- ` cbb- L94A\ 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 r County License: CAC014619
If value of construction is$2500 or more,a RECORDED Notice of Comme cement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN.FORMATIO.N:.: .
DESIGNER/ENGINEER: _Not Applicable MORT AGE.COMPANY: _Not Applicable
Name: Name:
Address: Addres :
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDI NIG 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 o 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, byla s or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review yc ur 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. LL cie County Amendments.
The following building permit applications are exempt from undergoing a fu I concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms ani I accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Comme cement may result in your paying twice for
improvements to your property. A Notice of Commencement ust be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, co sult with lender or an attorney before
commencing work or recording our Notice of Commencemen .
s
Signature of Owner/ ntractor as Agent for Owner Signatur of Contrac o/L ense Holder
STATE OFTLORIDA STATE OF FLORIDA
COUNTY OF COUNTYOF
The f ring instr ent was acknowledged before me The forg ing instrun ent was acknowledged before me
thisday of 20 �by this day of G cS 20 by
Nchitd
PA'
JO NiAR
S b
(Name of person acknowledging) ' ' My COMMISSION g ggq person acknowledging)
EXPIRES January 21,
(.to 71398-0153 FkWidallolaryServN {
Signature o1 otary Public-State of Florida)` Signat r of Notary Public-State of Florida)
r•gR;v4oNpgrflldflt9til y Q*1"r ua+•
Personally Known OR Produce entIITV1pt7 • .. rs nall Known_ _ . �_edit'd�?Rrfrea�'M:Jr-.
Type of Identification Produced 0z0z'I,z anuer 32i1OAZ fid
entification Prod ' = MY n
b 6z58d� NO 5 ;•. '�. 52884
!� EXPIRE January 21,2020
Commission No. ` -3111(va6ipf ..31il d n is ion No.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS