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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "�( l. Permit Number: /
RECEIVED
Building Permit Application
Planning and Development Services FEB 2 7 2017
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
PROPOSED IMPROVEMENT LOCATION:
Address: LA 05 F. 'F_<Ll F_' O!L P
Legal Description: 33 -3���`'Ec� S��l �{OC' N�,J`�L4^Liss rikco F-t L-lC,�z- oF- F__RkWCLS ,
AV
Property Tax ID#: \ti33 oe)o3 ^ c oo-- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'PtJ S-r prtL . O�y lo!'� 6 C-L i,t�r_� r�L_ ,„r.-i N „n R o o r o c/c^s�
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit—check a apply:
11HVAC F] Gas Tank Gas Piping _Shutters E]Windows/Doors
n
Electric 0 Plumbing Sprinklers FI Generator Roof Roof pitch
Total Sq. Ft of Construction: \;� G70 S . Ft.of First Floor:
Cost of Construction:$ Coo Utilities:In Sewer O Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Sy F F c> Sort Name: John E.Murray
Address:�o`.S r.F�i� �2 Company: AMS Inc: .
'941'SW 8 Street,"". -=,"
City:, ��-`--.P ��_ �� State C-L_ Address:; .
Zip Code:3 L-N,9 Fax: City: Pompano Beach State:FI.
Phone No. Zip Code: 33069 Fax: 954-782-0995
E-Mail: Phone No. 800-226-6677
Fill in fee simple Title Holder on next page(if different E-Mail: maryannp@amsofFla.com
from the Owner listed above) State or County License: CC C042787
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: JamesBushouse Name:
Address:1550 N Andrews Ave Address:
City: Pompano Beach State: Ff.. City: State:
Zip: 33069 Phone: 954-956-2203 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: XNot Applicable
Name: K ci- Ct (Ar►-Fj t_.pptF_S T4v e- . Name:
Address: Z-% -t S. oc< Address:
City: F-1- City:
Zip: -1L%S 91A6 Phone:` 7 7a Lk(=\- 1 a0x 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/Contractor as Agent for Owner Signatu Contract r Licen Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF G-r- L,J C�'F-= COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 4day of_��S3ct.�.4n-� 20 VD by this�day of 20 I by
Sy F _ e1T S O rJ John E.Murray
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known fit _OR Produced Identification Personally Known C(OR Produced Identification
Type of Identification Produced Type of Identification Produced
°1�,RY Ibg� ALAN MILLER o��ar Pang• ALAN MILLER
Commission No. c o
*(I�®QJ�v1MISSION#FF 195499 Commission No. * W04MISSION#FF 195499
EXPIRES:May 5,2019 a EXPIRES:May 5,2019
OgnUed Thru Budget Notary Services f�rE oayO Bonded Thru Budget Notary Services
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE i
COMPLETE
INITIALS