HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
4(0 Date: tO.D 2, 1 QA GJ�Qj SCANNED Permit Number: I� _
BY
St. Lucie County RECEIVED
Building Permit Application OCT 2 2 201E
Planning and Development Services
Building and Code Regulation Division sT. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 --
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION: I III
Address: !ja76,Q 1 0 5 L4Wu ( I 40CW `76 1 9Uz C�1-- 3H45Z.
Legal Description: ST LUCIE GARDENS 26 36 40 BLK 3 PART OF LOTS 12,13,14 AND 15 MPDAF
Property Tax ID #: 3414-501-1912-500-6
Site Plan Name:
Project Name: CORLEONE'S ITALIAN RESTAURANT
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
IIDETAILED DESCRIPTION OF WORK:
INSTALLATION OF ILLUMINATED WALL SIGN, CONNECT TO EXISTING ELECTRICAL SUPPLY
FROM OLD SIGN. INCLUDES REMOVAL OF OLD SIGN.
CONSTRUCTION INFORMATION:
itiona wor to a er orme un ert is permit—checka
apply:
❑HVAC 13GasTank ❑Gas Piping
In _Shutters
❑Windows/Doors
R1Electric El. Plumbing Sprinklers
nGenerator
❑Roof ❑ Roof
pitch
Total Sq. Ft of Construction: 14
S Ft. of First Floor:
❑Septic
Cost of Construction: $ 3,450.00 Utilities:11Sewer
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name A-yoc,.
Name:_ •ZVF,S.e.T 6-2*4-i V--
Address: in%4 52
Company: FLAMINGO SIGNS
City: Stater
Zip Code: -22'Y" 3 Fax:
Phone No.807.5771
Address: j4L4'4q 5 , Nr�NtK �7`r
City:-4rVAA_ State: FL
Zip Code: 34997 Fax: 220.7768
Phone No. 220.7377
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: FLAMINGOSIGNS@AOL.COM
State or County License: ES 12001146
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name: _Vw4 416 DA,. c-
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address: faan� 51 eew"1
A,7`c
Address:
City: W oa a 5B- 4x-)
Zip: �,3N5 Phone a!-a(��
State: �•
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
vNot Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
SUPPLEMENTAL CONSTRU N LIEN LAW INFORMATION:
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
im ens o yo rty. A Notice of Commencement must be recorded and posted on the jobsite
ore the first inspection. If y tend to obtain financing, consult with lender or an attorney before
ommencin work or recordingou otce of Commenceme
Rev. 8/2/17
Si ature of Owner/ L ssee Co or as Agen for Owner
ure o ontra se Ho e
STATE ORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF Gyl y1 �-7 / /N
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 2'Ldayof 0&7or7&1 .201C' by
this L<—day/o1f DavaQ�l� .20 �Yby
AdOEa7 U-�GJl./f✓
�(�8rn7 U'/LALn<
Name of person making statement
Name of person making statement
Personally Known ✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identifical7Pn
Type of Identification
�CceKSB
Produced �/vrAs -ICL�J+Se
Produced OM,i�/�s
(Signature of Notary Public-S
ignature of Notary Public-S e o Florida )
a^y�� Notary Public State of Florida
�L' � ? � B®B M Rice
Commission No. '� . (My �missionGG07277s
� e
G-� Q % �7 lejR '� �ilMio State of Florida
mmission No. Rice
"�'orwo� F�cpircs 04/03/2021
��e My Commission GO 072776
or rya ExPIres 0I/03/2021
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