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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 !'
PERMIT TYPE:
PROPOSED IMPROVEM NT CATION:
Address: 91 C=1 h 01
Property Tax ID#: j"� "�C�C3'O�ICJ_��( Lot No.
Block No.�
Site Plan Name:
Project Name: ic', o
DETAILED DESCRIPTION OF WORK:
n s't41 1k 'I 'iVb ulctf_ j 114'k
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ j '5Fy Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:'
CONTRACTOR: J _V
Name �`� # i �� Name: JAMES E REYNOLDS
Address: 'Uo Company: CORAD INC
City: ?St— State: Address: 2771 VISTA PKWY STE F11
Zip Code: 3`I Ci S o� Fax: City: WEST PALM BEACH State: FL
Phone No. 722, 3 b ' g(p Zip Code: 33411 Fax: 561-771-0049
E-Mail: Phone No 561-771-0047
Fill in fee simple Title Holder on next page ( if different E-Mail REBECCA@PERMITGROUPFL.COM
from the Owner listed above) State or County License CGC 054348
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: '
Name: I
Address: I
Address:
City: State:
City: State:
Zip:
�
Zip: Phone:
— —Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable i,
— —
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip. Phone
Zip: Phone:
----— - --
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
A-1
I � -
Signatur f Owner/ Lessee/Contractor s Agent for Owner Signature o Contractor icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
The forgoing instrument as acknowledged before me The forgoing instrum nt w�s acknowledged before me
this�3 day of ,or' I _, 20� by this �3 day of 2 by
I
J AMES E REYNOLDS JAMES E REYNOLDS
Name of person making statement. Name of person making atement.
I
Personally Known OR Pr uced Identification Personally Known OR r d Identification
Type of Identification Type of Identification
Produced Produced ob,_
4K
g Re fry P� Myc,�a�,� s
9a E FS�
Ss Ah OfPen./ ' �a o Ah aF
(Signature of Notary Public- State of Flori 70?� eSea�e,! (Si ature of Notary Public State of Flori �' gse�6
Commission No. (Seal) mmission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.