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ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` Permit Number: 0 A5
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RECEIVE®
Building Permit Application SEP /9 2015
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: 9113 One Putt PL
Legal Description: LAKES AT PGA VILLAGE(PB 43-32) BLK C LOT 16(OR 2187-897)
Property Tax ID#: 3334-501-0118-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK:,
A/C CHANGE OUT 4TON K w 10 15-° c5 562�7�
CONSTRUCTION INFORMATION:p
Additional work toe nertormed under this permit—check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:,
Cost of Construction:$ 4300 UtilitiesSewer OSeptic Building Height:
OWNERAESSEE: r. CONTRACTOR: u
Name William L Hackett Sr Margaret C Hackett Name: RICHARD LEVINSON
Address:9113 One Putt PL Company: Service America
City: Port St Lucie, State:FL Address: 2755 NW 63rd CT
Zip Code: 34986-3097 Fax: City: Ft. Lauderdale State:FL
Phone No.772-579-3629 Zip Code: 33309 Fax: 954-977-3591
E-Mail: Phone No. 954-979-1100 X5673
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,scree oms and accessory uses to another non-residential use
Vbee
TO OWNER:Your failure to Record a Notice C m cement may result in your paying twice for
ents to your property. A Notice of`C�q�men m nt st be recorded and posted on the jobsite
first inspection. If you intend to obtain a in n ult with lender or an attorney before
in work or recordingour Notice of Comme t.
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r Si 0e o , Le"ssee- ent Si ature of Co. - for License Ho er,_,
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Thefo oing instrument as acknowledged before me The forgoing instrumenywas acknowledged before me
this�day of 201 U by thi�day of -( 20 (0-by
(Name of persona n le gin (Name of person ackn le gin
(Signature o tary P -St of Florida) (Signa paryFlorida)
Perso ally Kn wn OR Produced Identification Personally owced Identification
Type of Iden Ification P duced T pe of Id ntifica§ �� Co Ission No. Seal
Com is ' n No. ;£"" y;''•, JE TSON
MY COM #FF 072984
EXPIRES:November 25,2017 ,o� Y P JESSICA DOTSON
IMY COMMISSION#FF 072984
Revised 07/15/2014 p `off: EXPIRES:November 25,2017
of Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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