HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: )U01 " MRD
1
illy,In WIN11111P a 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
PERMIT APPLICATION FOR: Mechanical
PRbP05ED IM;P`ROVEIVI'ENT.LQCATION:: '
Address: 105 SE SELVA CT
Legal Description: RIVER PARK-UNIT 7- BLK 66 LOT 6 (MAP 34/28S) (OR 1455-2443: 1552-784 ; 1769-373)
Property Tax ID#: 3419-550-0057-000-9 Lot No.
Site Plan Name: August L Tange Sandra A Jacobs Block No.
Project Name: August L Tange Sandra A Jacobs
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AC CHANGE OUT 2.5TON 16SEERS '^ '7 -57 VW'
CONSTRUCTION INFORMATION
_r
Additional work to be nertormed un ert ispermit—check a appy:
ZHVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 4187.00 UtilitiesSewer Septic Building Height:
OWN,ERAESSEE:' CONTRA"CTTOR:
Name August L Tange Sandra A Jacobs Name: RICHARD LEVINSON
Address: 105 SE SELVA CT Company: SERVICE AMERICA
City: Port St Lucie State:FL_ Address: 2755 NW 63RD COURT
Zip Code: 34983 Fax: City: FORT LAUDERDALE State:FL
Phone No.772-879-9813 Zip Code: 33309 Fax: 954-977-3591
E-Mail: Phone No. 954-979-1100 EXT 5673
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.
SURPLEMENTAL CONSTR'UCTION..LCEN ,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 r ms and accessory u�es to another non-residential use
ARN TO OWNER:Your failure to Record a Notice of o mence ent maylresult in your paying twice for
i pro nts to your property. A Notice of Commenc ane t mu b recor ed and posted on the jobsite
e ore he irst inspection. If you intend to obtain finan ing, con ItIth len er or an attorney before
QE ncin work or recordin our Notice of Commen nt.
M � —
s
_Slg tl7te of'O�niner/Lessee/7�gentSign ure ontraetor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SAINT LUCIE CO U NTY 0 F SAINT LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 _by this 15 day of 1 20 by
RICHARD LEVINSON RICHARD LEVINSON
(Name of person ack o le ) (Name of person c nowledging)
(Signate of No ry P to of Florida) (Signatu.r• u lic-State of Florida)
Perso/ally K IndIdentif ation P r/so/Hall Known x OR Produced Identification
Type f]de • „ ;Pr ON#FF 072984 ype of dentificatio t `
'*E EXPIRES:November JESSICA D
<°`�Y P�p4'= MY COMMISS IFON
F 072984
COmmissiOn o� BondedThruNotaryPub1'cUn erwnters N5,2017
Commission No. :*: *_
'1�••••b2' sonded7hruNotaN PUblie Undermf(Iters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS