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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PROPOSED IMPROVEMENT LOCATION:- .
Address: 13933 ADELFA AVE
Legal Description: AC CHANGE OUT 3 TONS 16 SEER
Property Tax ID#. 1306-501-0082-000-8 Lot No.3
Site Plan Name: SPANISH LAKES FAIRWAYS LEASEHOLD ESTATE Block No. 5
Project Name: SERVICE AMERICA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ' u'
AC CHANGE OUT 3 TONS 16 SEER 7.5 KW
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit–check all that appy:
❑✓—HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 4095 Utilities:Sewer[]Septic Building Height:
OWNER/LESSEE:, CONTRACTOR,.' t
Name ROBERT DITTMAR Name: RICHARD LEVINSON
Address: 13993 ADELFA AVE Company: SERVICE AMERICA
City: FORT PIERCE State:FL Address: 2755 NW 63 CT
Zip Code: 34951 Fax: City: FORT LAUDERDALE State:FL
Phone No.772-465-4682 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.
1
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,screen rooms and accessory uses to another non-residential use
AWARNING TO OWNER:Your failure to Record a Noti e f Co mencement may result in your paying twice for
ovements to your property. A Notice of Commem must be recorded and posted on the jobsite
the first inspection. If you intend to obtain fin i g, nsult with lender or an attorney before
m cin work or recordin our Notice of Comm a t.
S
Owne see/Contractor asAgen rr Ow er Signat o , ontracto%/Licens Hold 'r
STATE OF FLORIDA &OW04
STATE OF FLORIDA
COUNTY OF COUNTY OF bowafy
The fgrgoing instrument was acknowledge] before me The for ling instrument s acknowledged before me
this j( day of "V 20 (t-by this day of 20 Aa by
•C�bfd L&V os 0/ LJ& -Lu ws m
(Name of person acknowledging) (Name of person acknowledging)
& J�4
Signature of otary Public-State Florida) (SignaturvyKnown
f Not Public- ate of Florida)
Personally KnownOR Produced Identification Personal � OR Produced Identification
Type of Identification Produced Type of Identification Produced
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;ui+:o�B SHER W Commission No. ,• Y'Y • SHERIfW1N `(7� �2
Commission No. =` ``= COMMIS COMMISSI FP065
.EXPIRES:October 21,2017 '*_ EXPIRES:October 21,2017
bonded Thru Nota Public Unde v.Aers :o?` hru Nota Public unde'%iters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS