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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ^3 t-UL-2 Permit Number: �tou -Ct1X3yr��-,n
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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 XXX Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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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 li 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.
Site Plan Name: Road Runner Travel Resort Block No.
Project Name: �yGs
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itiona wor to e e Orme under tis permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing ll�y Sprinklers Generator Roof
Total Sq.Ft of Construction: !�/"I �- 5 .Ft.of First Floor:
Cost of Construction:$_/ t70, Vy Utilities:]Sewer H Septic Building Height:
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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:
E-Mail: sean@roadrunnertraveiresort.com Phone No. (772)465-4355
Fill in fee simple Title Holder on next page(if different E-Mail:
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.
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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:
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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 perm it,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 recor iing your Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
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STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF S �U`�/`C� COUNTY OF
The for ing instrument was acknowledged fore me The forg 'ng instrumpt was acknowledged before me
this day of ZO [. by thisday of �lU .20 Ay
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1 SOP..! /GLl/-1
(Name of person acknowledging) (Name of person acknowledging)
ax� aP&'L_)
(Signature of Notary Public-State of Florida) (Signatu a of Notary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known '/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
fir- a 3 i 6 yP` �H1A BAKER
Commission No: YP a mmission No. rr�� f�� fY1 ISSION#FF231810
f THIA it E%PIRES:June 29,2019
My COMMISSION 9 FF231 10 o�F,
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
I COMPLETE
INITIALS
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