HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 3 L��� Permit Number:
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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 Residential XX
PERMIT APPLICATION FOR: Pool inground
PROPOSED IMPROVEMENT LOCATION:
Address: 13321 NO 6AY&J000 PLACE PALM C19y fL 34590
Legal Description: Rlvf=i &MD .PB &7-3(o) W-( 31
PropertyTax lD#: y425- 703-0036 -006 -6 Lot No.
Site Plan Name: Block No.
Project Name: gCulul s/"CE
Setbacks Front Back:5I Right Side�Left Side: m
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be nertormed un er t is permit-check a apply:
11HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers E Generator El Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$_(g0,Q60.00 Utilities: Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Q.55ELLA CCL)/LD J Name: Ryan Figman
Address: /.332/ A10l�A�/lilOo4/ Ac6 Company: Apex Pavers& Pools
City: 19AA C/IN State:FL . Address: 725 SE Monterey Road
Zip Code: 30go Fax: City: Stuart State:FL
Phone No. 772- 2 3-9-4.30 Zip Code: 34994 Fax: 772-419-5101
E-Mail: Phone No. 772-419-5151
Fill in fee simple Title Holder on next page(if different E-Mail: Jscalise@apexpavers.com
from the Owner listed above) State or County License: CPC1458696
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU
PPLEMENTAL 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 wor or recording our Notice of Commencement.
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Signs 0 r/ essee/Contractor as Agent for Owner Sign ture yf Contra to /License Holder
STATE OF FLORIDA STATE OF FLOffjjIDA
COUNTY OF MAP-71 N COUNTY OF MAP-71V
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 22 day of MAWA 20/1-by this ZZ day of 1404R-W 20 [Z by
6SSEZL A U AkD I Ryan Fgman
(Name of person acknowledging) (Name of person acknowledging)
- Z��� . /0'JXZ'1 — x&e,—_"'," I—
(Signature of Notary Pub c-State o rida) (Signature of Notary Pub c-Stat lorida)
Personally Known OR Produced Identification Personally Known � OR Produced Identification
Type of Identification Produced k-DL AQ6373dr•(43--V(W 0 Type of Identification Produced
S.?r."y''•• DOREE BU A
Commission o,.,"�o ENJ.BUF�aI Commission No. ;?a' �:
MY COMMISSION#FF M213 Y COMMISS� 928213
EXPIRES:January 3,2020
EXPIRES:January 3 2020 '% dd 4' Bonded Thru Notary Public underwriters
„gP�y°• Bonded Thru Notary Public Underwriters
Revised 0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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