HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 03.(3 LQI
MOW 19 1 RECEIVED
Building Permit Application AUG 3 0 2011
Planning and Development Services
Building and Code Regulation Division ` Ei:WI TIN"
2300 Virginia Avenue,Fort Pierce FL 34982 1_+.1cie Coun:y, F!
Phone: (772)462-1553 Fax: (772)462-1578 Commercial XXX Residential
PERMIT APPLICATION FOR: Concrete
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PRO_POSED,IM{?ROVEMENpT LOCATION:= " �
e
Address: 5500 Saint Lucie Blvd. Fort Pierce, Florida 34946
Legal Description: 30 34S 40E 30 34 40 Beg at SE Cor SW 1/4 of SW 1/4 Run W on S Ii of SD SW 1/4 of SW 1/4
333 Feet, Th N to PT on Li of SW 1/4 of SW 1/4 331.2 feet W of NE Cor of SW 1/4 Continued on Tax Roll
Property Tax ID#: 1430-331-0001-000/8 Lot No. A/— ®(6
Site Plan Name: Road Runner Travel Resort Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE5 I.PTION OF WORK
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CONSTRl1CTIONrINFORMAfiION n
Additional work to bortormed under this permit—check all appy:
In
HVAC Gas Tank _ ❑Gas Piping _Shutters , Q Windows/Doors,
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ 02 �7� Utilities Sewer Septic Building Height:
OWNER/LESSEE: - -CONTRACTOR, —
Name Marilyn Minix Name: Lori Williams
Address: 5500.Saint Lucie Blvd. - - Company: D &.M Concrete Constuction Inc.
City: Fort Pierce State: FI Address: 331 Sunrise Dr.
Zip Code: 34946 - Fax: (772)464-0987 City: Fort Pierce State: FL
Phone No. (772)464-0969 Zip Code: 34945 Fax: (772)468-8667
E-Mail: sean@roadrunnertraveiresort.com Phone No. (772)465-4355
Fill in fee simple Title Holder on next page(if different E-Mail: I ittle4bit331 @yahoo.corn
from the Owner listed above) State or County License: #24764
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ' _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address `s - 1' 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 recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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_Signature of Owner/Lessee/Agent''
essee/Agent', Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST. l.AkC.IF, COUNTY OF �"T: L A-CA
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this SO day of 14 V_G LLS 20 1by this 30 day of OL&G"-r ,20 1? by
UK CVNgl l m '84KCX,
(Name of person acknowledging) (Name of person acknowledging)
(Signatur of Notary Public-State of Florida ) (Signature of otary Public-State of Florida)
Personally Known_�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Fra 3 ''� P„�o C( BSER Commission No. VF a-3 C/ v
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