HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11� II�o Permit Number:JG 1I' �3y3
' r c771
RECEI'.'-D NOV 16 2016
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: To Select from dropbox, click arrow at the end of line V��
PROPOSED IMPROVEMENT LOCATION:
Address: 9253 SHORT CHIP CIR PORT ST LUCIE
Legal Description: LAKES AT PGA VILLAGE
Property Tax ID#: 3334-501-0142-000-0 Lot No.4
Site Plan Name: Block No. D
Project Name: PATRICE LEFEBVRE
Setbacks Front Back: Right Side: Left Side:
a
DETAILED DESCRIPTION OF WORK:
AC Change Out 4ton Trane 15.5 Seer O K.VJ
4TTR6048J 1000A/TAM4AOC6OS51
CONSTRUCTIC►N INFORMATION:
Additional work toe nertormed under this permit—check a appy:
❑✓_HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing 11 Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ $5319 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name PATRICE LEFEBVRE Name: Richard Levinson
Address:3276 Rue De La Seigneurie Company: Service America
City. Ste-Marthe-sur-le-Lac State:QC Address: 2755 NW 63rd Ct
Zip Code: JON 1 P Fax: City: Fort Lauderdale State.FL
Phone No.72-206-1557 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.
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\ncurrency review: room additions,
tc=,
ry structures,swimming pools,fences,walls,signs,screen rooms and auses to another non-residential use
Anc
TO OWNER:Your failure to Record a Notice of C encmay result in your paying twice for
nts to your property. A Notice of Commence ent ucorded and posted on the jobsite
irst inspection. If you intend to obtain fin ' g c n lender or an attorney before
work or recordingour Notice of Comm nc e t
IN_ s
Signa re of Own essee/Contractor as Agent for Owner Sig " ture of Con __ . ?/License Holder
STATE OF FLORIDA QQ ^� STATE OF FLORIDA _
COUNTY OF COUNTY OF
The f0r,901ing instrument was/acknowledg7jobefore me The for oing instrument/w�s acknowledged before me
this day of �l,+p V , 20 K!/_by this C day of I� '20,/J0 by
(016d t4y,t,&W? del(&rU "117SO12
(Name f erson acknowledging) (Name of erson acknowledging)
p4A — / L4k
i��
ignature of N tary Public-State ' n
Florida) ature of ary Public-Stat of Florida)
Personally Kno n OR Produced�1 — Personally Known OR Produced Identification
Type of Identifi Type of Identification P �t o
Si9'°trPy�6: �FIERIOq��- SHE1,FA
.*, MY COMMISSION#FF 065032 =* *- MY COM WHY
Commission No. ` EXPIRES:0=46'o1�017 Commission No. `. � IWFF065032
''• oQ Banded Thru Notary Public Un a a,iters EXPIRES;October 21,2017
h Qf•ice, 9f ° Bonded Thru Notary Public Undex iters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS