HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED e1
Date: � — ' I� �l�J Permit Number:
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RECEIVSD JAN 0 7 2016
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 APPLICATION FOR: Shed DCA =1
PROPOSED IMPROVEMENT LOCATION A
Address: 5500 Saint Lucie Blvd.
Legal Description: 30 34S 40E 30 34 40 SW 1/4 OF SW 1/4 LESS A STRIP OF LAND ON E BEING 331.2 FT ON N LI
&333 FT ON S LI (OR 322-2003)
Property Tax ID#: 1430-331-0002-000/5 Lot No.
Site Plan Name: Road Runner Block No.
Project Name:
Setbacks Front ( t Back: 9,11 Right Side: 1 s , Left Side: obt
DETAILED DE.SCRIPTION'QF WORK
Install Dfoot X 8 foot shed DCA
CONSTRUCTIO�ItINFORMATION a '' {+ k y _
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.,Additionalworkto a er orme under this permit—check a app y:
aHVAC E] Gas TankGas Piping _Shutters . 11Windows/Doors
Electric ❑ Plumbing Sprinklers a Generator Roof
Total Sq. Ft of Construction: � S . Ft.of First Floor:
Cost of Construction:$ 2 d� Utilities: U Sewer Septic Building Height:
01NNERJL ��; CONTRACTOR 3 -
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Name Marilyn' infix ;' " , ` v - ,� Name: W,
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Address.5500-Saint,Lucie.Blvd-?,ja7��^
Company:
City: Fort Pierce State: Fl. Address: 3 3 ( ti-1, -5C Dl'
Zip Code: 34946 Fax:772-464-0987 City: P-c- State y 25
Phone No.772-464-0969 Zip Code: 3 L(pf S_ Fax: ��c�"CYC 7
E-Mail:sean@roadrunnertravelresort.com Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: Q
from the Owner listed above) State or County License: `95 53'
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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5'UPPLEMENTAL CONffl RT"�TI®NM1EN LAW IN 'U.RIVIATI®N'7:
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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 thepermit 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. p
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Sign(
ig ture of 0 er/Lessee/Agent Signature of Contractor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST �u-C 1 COUNTY OF J
The fpr going instrument was acknowledged before me The forgoing instrument was acknowled ed efore me
this day of U-40144IN 20 f�a by this�day of�Y! 20� by
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(Name of person acknowledging) (Name of person acknowledging) i
(Signat re of Notary Public-State of Florida) (Signature of N t ry Public-State of Florida)
Personally Known OR Produced Identification Q.P c ion
Type of Identification Produc rodu lJFF
°tCYNTHIA BAKER ?� ��� Notary PabtiC-"State of Florida
Commission No.. � a3 (6@�I}IISSION#FF231810 Com g3 1 i'? Commission#FF2340WI)
oF�o ENME.S:June 29,2019 +rF e,°•` My Comm.Expires May 27,2019
Bonded through National Notar,
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS