HomeMy WebLinkAboutBuilding permit application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �; k Permit Number: 9 m
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)46271578 Commercial XXX Residential
PERMIT APPLICATION FOR: Concrete
PROPOSED IMPROVEMENT LOCATION:
Address: 5500 Saint Lucie Blvd. Fort Pierce, Florida 34946
Legal Description: 30 34S 40E 30 34 40 SW 1/4 of SW 1/4-Less a strip of land on a Being 331.2 Feet
on N LI &333 Feet on S LI (or 322-2003)
Property Tax ID#: 1430-331-0002-000/5 Lot No.
Site Plan Name: Road Runner Travel Resort Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove grass, form and pour concrete 4 inch.deep with 3000 psi fibermesh concrete aprox 640
square feet as per plan.
CONSTRUCTION INFORMATION:
Additional work to bfIrformed uncle r this permit-c ec a apply:
�HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: IQ qq SIn
of First Floor:
Cost of Construction:$ ;/� �i .• Utilities _Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Sean Minix Name: Lori Williams
Address;.5500..Sai,nt Lucie Blvd':' Company: .DA,M Concrete Constuction Inc.
City: Fort.Ferce _:. State: F Address: 331 Sunrise Dr:;
,.Zip-Code?.34.946. ,, ,. ,: ... Fax:`... 464-0987 City: Fort Pierce.i". State:, FIL
Phone No. (772)464-0969 Zip Code: 34945- . -Fax:
E-Mail: sean@roadrunnertravelresort.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.
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 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.
L-04
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C L vim« COUNTY OF 5-7-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this `Z—day of ®« 20 ZUby this Z?— day of 20 ZU by
(Name of person acknowledging) (Name of person acknowledging)
\'_�sm� '�4_ D2at:�]�
a�
(Signature of Notary Public-State of Florida (Signature of 14otary Public-State of Florida)
Personally Know OR Produced Identification Personally KnownOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.C'1Q agaS�S e I Commission Nd,= a Ia ,, ry
No ry� of Florida
Notary Public State of Florida Karr G
MY Commission GG 292585
Revised 07/15/2014pp
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS