HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: September 13, 2016 Permit Number:
F L C7 R F 0 A- �
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 X
Address: 9040 Champions Way Port St. Lucie, FL
Legal Description: Lakes at PGA Village Block A, Lot 32
Property Tax [D#. 3334-501-0046-000-7
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Lot No. 32
Block No. A
leuPp11 f ;R51411 _�6 P. eled6C_ Kla_�er A e�f�r� - f dl111 Vake-,
and (fXxp tnSl4n tllll�'e fo 11'A -e)
CONSTRUCTION INFORMATION:
Additional work to be e orme under this permit— check a appy:
E1HVAC f Gas Tank ❑Gas Piping_ Shutters Windows/Doors
Z t
11 Electric Plumbing Sprinklers F Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 900.00
S. of First Floor:
Utilities:] Sewer OSeptic Building Height-
OWNER/LESSEE:
CONTRACTOR:
Name Gerald Smith
Name: Gary UV_ Zanello
Address: P O Box 372
Company: Port St. Lucie Plumbing
City: Lewiston State:MI
Zip Code: 49756 Fax:
Phone No. 772 828-9455
Address: 6907 Heritage Dr
City: Port St Lucie State: FL
Zip Code: 34952 Fax: 772 489-9126
Phone No. 772 468-6524
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: portstlucieplumbing@gmail.com
State or County License: CFC058025
It value or construction or more, a KtLUKE)tL) Notice or commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 Horne 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 l 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
LUrrlrneFIUIFl9 WL)Fr, Ur FUWraIF] P, your IYotice Q1 t-urnMencement.
A/C Vhil"ll-la
S
Signatur 11
Own essee ontractor as Agent for Owner SignaturrF
ontract /License Holder
STATE OF FLORIDA STATE A
COUNTY OF St Lucie COUNTY OF st-cfe
The for oing instrum int was acknowledged I efore me
this IJ day of 20 1by
Gary W. Zanello
(Name of person acknowledging)
The forgoing instrument was acknowledged before me
this 13th day of September 20 //0 by
Gary W. Zanello
(Name of person acknowledging)
l
(Signature of Notary Public- a of Florida) (Signature of Notary Public- &
a of Florida }
Personally Known x OR Produced Identification
Type of Identification Produces,,,
Commission No. FF901099 r= (SeOMMISSioN JFF901M
EXPIRES: August 25, 2019
Revised 07/15/2014
Personally Known x OR Produced Identification
Type of Identification Prod r.
��y �+t
Commission No. FF90109$� _ # iFP94t099
�RE5: gust 25.2("9
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