HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: < 0 '' i♦� Permit Number:
RECEIVE®
0
Building Permit Application OCT 12 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: To Select from dropbox, click arrow at the end of line
a
PR`OPOSED,IMPROVEMENT'LOCATION.:
Address: 9650 S Ocean Dr Apt 506
Legal Description: THE PRINCESS OF HUTCHINSON ISLAND UNIT 506(OR 3355-2919)
Property Tax ID#: 4502-610-0046-000-0 Lot No.
Site Plan Name: Parvin Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF",WORK:
AC CHANGE OUT 3.5TON tA elliot CLAM P t 0
CONSTRUCTION_ INFORMATION:
Additional work toe e Orme under this permit—check a appy:
ZHVAC E] Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . of First Floor:
Cost of Construction:$ 4900 Utilities:n Sewer Septic Building Height:
OWNER/LESSEE:. . :,� CONTRACTOR:
Name Kenneth Parvin Name: RICHARD LEVINSON
Address:9650 S Ocean Dr Apt 506 Company: Service America
City: Jensen Beach, State:FL Address: 2755 NW 63rd CT
Zip Code: 34957 Fax: City: Ft. Lauderdale State:FL
Phone No.772-446-4972 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: '-
DESIGN ER/ENGI NEER:
NFORMATION: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 recpfled and posted on the jobsite
before the 'r t in ection. If you intend to obtain financing, consultor or an attorney before
commen n wo or recordingour Notice of Commencement.
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Ow /L ss_ee A entcur Y;ofCantractoc/License Holder
xS-TATEORIDSTATE OF FLORIDA
COUNTY OF DA,,
n`f ( ,'t.0 COUNTY OF ' —Vy-\i L.(s :4
The for in instrument was a nowled ed ore me The forgoing instrume as acknowledged before me
i
this Pay of I 20 by this day of 20/-6—by
(Name of person ackno le ing (Name "f pers n dgin )
(Signature o otar Pu -State of Florida). ,(Sign o N ry Public-State of Florida)
/ Person I Kno �iY °" —�
:+ '`' 0 PrdtiSB!egdd tfica
Personally Know OR Produced Identification Y 9�R#
Type o Identifi at ion P duced Type f Identif r�du��COMMISSIONgFF072 841
Gonaetl ihru Notary ub er 25,2017
Commi No. (Seal) 0mmission No. ers
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS