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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/13/2017 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: To Select from dropbox, click arrow at the end of line
FS
Address: 4100 N HIGHWAY AIA#132
Legal Description: TREASURE COVE DUNES UNIT 132 (OR 3431 - 591: 3728-1916)
Property Tax ID #: 1423-502-0007-000-2
Site Plan Name:
Project Name:
Setbacks Front Back: -
Right Side: Left Side:
WATER HEATER INSTALLATION/ CLOSET / 40 GALLON
Lot No.
Block No.
Additional work to be pertormed under tnls permit— cnecK all apply:
HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing O Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: 0 Sewer R Septic Building Height:
Name Thomas J. Ciccalone Jr.
Address: 4100 N A1A Apt: 132
City. Fort Pierce State: FL
Zip Code: 34949 Fax:
Phone No. 860-808-4204
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Don Miranda
Comoanv: Miranda Plumbing & Air Conditioning
Address: 750 NW Enterprise Dr # 100
City: Port St. Lucie State: FL
Zip Code: 34986 Fax: 772-871-0863
Phone No. 727-878-5123
E -Mail: alopez@mirandacompanies.com
State or County License: CFC1427227
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
. Not Ap
Name:
Address,
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: --
Address: --
City: State:
Zip: Phone:
BONDING COMPANY: __,_Not Applicable
Name: _
Address:
City:
Zip: Phone:
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 theermit holder to build the subject str cture
which is in conflict with any applicable Home Owners Association rules, bylaws or andcovenantsthat 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 first ins ec ion. If you intend to obtain financing, consu tl:-ierieitar-aJ,i attorney before
Signature of Owner/ Lessee/Agent C
STATE OF FLOAI A
COUNTY OF
The forgoing instrument was acknowledged before rig .x z
this day of 20 by a .12Lo
r n^ D
(Name pf person acknowledging) ,,�j
of Notary Public- State
Personally Known Ll_�OR Produced Identification
Type of Identification Produced
Commission No.FP (Seal)
Revised 07/15/2014
re
STATE OF FLOR
COUNTY OF :W
The forgoing instrument was acknowledged before m
this day of 120 by e
(Name of g4rso`n acknowledging)
of WWtary Public- State of Florida )
Personally Known i/ OR Produced identification
Type of identification Produced
Commission No.Cr-- % (Seal)
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