HomeMy WebLinkAboutBuilding Permit Application I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
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PERMIT APPLICATION FOR: Mechanical
'P,'ROPO'SED'IMPROVEMENT LOCATION''.'
.Address: �0�1 t Q a . �i CO , ?��la�
Legal Description: Pf�Mamc
cov- 3i�AG - v3(n-
Property Tax ID#: \.A\`a &0_ 0()\b 000 -b Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK .
.
i C� -P\l) C ( �� GA S 1 .,'� 5�9. - /yam -r PU M 0
CONSTRUCTION INFORMATION:,
Additional worK toe performed un er t is permit-c ec a appy:
0✓ HVAC 0Gas Tank F_]Gas Piping _-Shutters 0 Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ �1�ZJ Utilities.
Sewer Septic Building Height:
'OWN'ER/LESSEE {
. .,A. CONTRACTOR; �. - .�• „ ,a �: •
Name ?C% CA 7iLXC�CC: � Name: RICHARD LEVINSON
Address:5M1 kA N f • 02> Company: SERVICE AMERICA
City::F0f;T Pi�JQQ State:li'- - Address: 2755 NW 63RD CT
Zip Code: Fax: City: FT LAUDERDALE State:FL
Phone No. 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 CONSTRUCTIOU LIEN LAW IN°FORMATIOhl:' ,
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:
jCity: City:
IZip: Phone: Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
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'St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
Iwhich 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.
i 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
comrrhncing work or recording our Notice of CommencemenM.
_4A__ qa_LL
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIQUL ��ii STATE OF FLO DA
COUNTY OF 5(oell`C� COUNTY OF j gOrd
The forgoing instrume t was acknowledged efore me The forgoing instrumentw s acknowledged before me
this day of — 20 �by this 19� day of 20 LZ by
Dyd,.,cl P\�"nd Leo ,tis0 n
(Na of person acknowledging) (Name of person acknowledging)
(Signature of N Public-State of Florida) (Signature of Public-State of Florida)
Personally Knowri en i i tion Personally Known '� OR Prod��rad itaPnfi}f}�,+;ten
Type of Identificatio Po rGe r Debbie Jew,les�. Type of Identification Pro u y P1 jouffrip-,
Notary Public #GG 7
#GG 7066$ s � {� Nola Public-State ofFlarida
Commission No. comivwp Commission No.
Expires � o` C�rt��ion#GG70666
OFF V9rF ots`OFF Expires 2/712021
Revised 07/15/2014
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j REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS