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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED aq
Date: Permit Number: OL)q ®ig5-
. RECEIVED
Building Permit Application APR 0.4 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St.Lucie County
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Concrete
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Address: 12780 NW MARINER CT PALM CITY FL 34990
Legal Description: MARINER VILLAGE HARBOUR RIDGE- PLAT 4- UNIT 19 (OR 2008-787 : 2761-2291)
Property Tax I D#: 4425-603-0031-000-4 Lot No.
Site Plan Name: HARBOUR RIDGE Block No.
Project Name: MARINER VILLAGE
Setbacks Front Back: Right Side: Left Side:
form and pour a 80" X 42" X 6" with 4"steel mesh and 5000 Ib ready mix bag concrete
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Additional work toe nertormed under this permit—check a appy:
HVAC Gas Tank OGas Piping _Shutters Q Windows/Doors
E]Electric 0 Plumbing Sprinklers Generator .Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 450.00 Utilities: IJ Sewer ElSeptic Building Height:
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Name ROBERT.H&SUSAN I RIED Name: JEFFERY J PAULY
Address:12780 NW MARINER CT Company: JEFFERY J PAULY CONSTRUCTION INC.
City: PALM CITY i State:FL Address: 2420 SW MAPLEWOOD DR
Zip Code: 34990 Fax: City: PALM CITY State:FL
Phone No.772-285-2530 Zip Code: 34990 Fax: NA
E-Mail:susanried@hotmail.com Phone No. 772-263-8268
Fill in fee simple Title Holder on next page(if different E-Mail: jjpcbc.jp@gmail.com
from the Owner listed above) State or County License: CBC 047770
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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 thepermit 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 #-o- r Notice of Commencement.
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Sign r f w c o er/Less a/Co as Agent f er Sign e f o t c or/Lice e H er
S ATE OF FLORI A STATE OF FLORIDA
COUNTY OF faC'an��� COUNTY OF COOA�io
The forgoing-instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9, day of fA Qn 20 16 by this C day of 20 —
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(Name of person nowledging) (Name of person cknowledging
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(Signature of Nott Pub' -State of Florida) Wnature of Notry P c-State of Flori a)
Personally Known OR Prod ced Identificatior Personally Known OR Produced Identification
Type of Identification Produced -LDL Type of Identification Produced L
Commission No. G ,.1; Y'N�BEeal) ASHLEYZAWADZKI Co mission No. G 1
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DATE
COMPLETE
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