HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 51\`11\dl SCANNtL1 Permit Number: 1°�d5-0343
BY
*mot t St. Lucie Coilrnv
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEIVED
Building Permit Applicatio MAY 14 2019
ST: L-dbld EgdH€yf IrBPf?il€€IHtI
Commercial X Residential
PERMIT TYPE: interior renovation
PROPOSED INPROVEMENT LOCATION:1510 US Highwayl
Address: 7510 US
Property Tax ID #: 3422-856-0002-000-8
Lot No.
Site Plan Name: Prima Vista Crossing Replat No. 1 (PB 41-31) Lot 2 (OR 3357-2801) Block No.
Project Name: Zen Leaf St. Lucie
DETAILED DESCRIPTION OF WORK:
TENANTIMPROVEMENT- CONSTRUCTION OF NEWMEDICALMARUIJ DIBPFNSARY WITHIN AN E%BTINGBUILDINGS113. TO INCLUDE NEW INTERIORPARTITIONSSFINISHES,PLUMBING. ELECTRICAL a MECHANICAL
IMPROVEMENTS.OPERATION OF THE DISPENSARY SHALL BE STRICTLY SALES NO MANUFACTURING. PREPARATION OR ALTERATION OF THE PPE-PAGKAGED PRODUCTS SHALL TAKE PLACE INSIDE THE LEASED SPACE
Additional work to be performed under this permit —check all that apply:
X Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
X Electric X Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 2287
Cost of Construction: $ 000
Sq. Ft. of First Floor: 2287
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Zen Leaf
Name: Michael Sullivan
Address: 7510 US Highway 1
Company: Sullivan Construction Company
City: Port St. Lucie State: _
Zip Code: 34952 Fax:
Phone No. (352) 636-0626
Address: 5310 NW 22nd Avenue
City: Fort Lauderdale State: FL
Zip Code: 33309 Fax:
Phone No 954-484-3200
E-Mail:—hollis.lillard@wirepropertygroup.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail amanda@buildwithsullivan.com
State or County License CGC1511223
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.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name: N/A
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name: N/A
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 r ult in your paying twice for
improvements to your property. A Notice of Commencement must �e reco d and os the jobsite
before the first inspection. If you intend to obtain financing, coWulXwit an attorney b
mnre I�
rnmprina wnrk nr renruJ, dinE vnr Notice of CommenremeiaN
Si natur o er Lessee/Contractor as Agent for Owner
gna of Co se older
S E OF FLO
STATE OF FLORIDA
COUNTY OF CA
COUNTY OF 'Pyrouxa.s
The foxing instrument was acknowledged before me
Ldayof
The for oing instrum nt was acknowledged before me
tN1 �qby
this 20_5by
this day0
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Ide tification _ �f
Produced L�- �St{.J��' 9 l,"Z1�o• O
Type of Identification
Produced
(Signature of terry Public- Statetn �rid[VI) ' ary
ISignature of Notary Public -State of FI TARY PUBL
�y NOTARY PUBLIC
Commission No. 2� - SBOTEOF FLORIDA
��� STATE OF FLO
Commission No. o�� .--
-IT? Comm# GG289925
Comm# GG289
W ONCE
teh° Expires 1/9/2
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