HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: �r 5- / 7 Permit Number:
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: Demo /i'f i 0A
PROPOSED 1N`PROUEMEN� LOCATION;
Add ress: X 0 72 J' S, 0 c e9,, D,- . J-eil-ren Rea ch ! I�CG . M? -7
Legal Description: !/0 kaG y Ov f A f �f Gv<•y J,?XY" 3 5,y)
Property Tax ID#: 1-15-1///- 5-0.2 0017"000 -J Lot No.
Site Plan Name: Y 0Block No.
Project Name: y9�
Setbacks Front Back: Right Side: Left Side:..
DEl' ILED DE�SCR+I� T10'N OF WO'RFK: /
COn, e fe Pr�7 �i f a A.-ul /0 . ro0m
CONSTRU@ fil I ONJ[NFORMATINN:
Additional work to be pe orme un er this permit—check all that appy:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing`` _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: y62
Cost of Construction: $ 170ao.. Utilities: 'Sewer _Septic Building Height:
OW 1ER/ E78� CO x Tp,R•
Name _ :au.1` 'W. d 74-,"MX J Name: .;:..
Address: �072.� S Qcey� .��. y717 :'Com`pany/�i,[Grn �'✓ f�o6cof ,wIC. ;17c.
City: State::FL Address:
Zip Code: Fax: City: ,Teh Bch +c4e State: /CL.
Phone No. 7/7- yy3"-2 Zip Code: 3y95"7 Fax: 7-7,2'.2132 9/
E-Mail: Phone No 77,Z' 2d07-71:5'-
Fill in fee simple Title Holder on next page (if different E-Mail ad/c MX,";f'!, �,?< ( ya�ao ' com
from the Owner listed above) State or County License CBC /.2 Jam/y�l
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPP' E ENTAL CONSTRUCTION 13RE N LAW IN'FORMATI®N:
DESIGNER-/ENGINE' _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applica BONDING COMPANY: Not Applicable
Name: me:
Address: Ad s:
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 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. Ile
Signature of Owner/Lessee Contractor as Agent for Owner Signature of Coritractor/License Holder
STATE OF FLORID STATE OF FLORIjT?j
COUNTY OF % �!l�� ��tt�/J COUNTY OF
The r oing in t was cknowledged before me The for o'ng in t was a knowledged efore me
t�da of 20 by thida of 20 by
7
(Name of p n acknowledging) (Name of p on acknowledging)
ArIlE
(Signature of Notary Public-SdtqjZf Florida) (Signature of Notary Pub' to of Florida )
Personally Known OR Produced Identification Personally Kno n OR Produced Identification
Type of Idqw6tioa Type of I e at' �,
Produced ed
;o.*a'•6g�s IMEE SHERIFF �j �7 ,+`Rr:"''o AIMEE SHERI
ommission #GG 3 :°_°�* °B` ommission #GG 20!37
Commission No. _ al� Adm fission N 6�CJp( st _ atj
y Commission Expires 3 0.� My Commission E pi ?s
September 13, 2020 September 13, 0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ., SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014
.PlanningBDevelopmentSeMcei ASBESTOS NOTICE
Build(_eg 8iPode:Regulabon DMilon,
2300.Virginia Avenue
Fort Plerce,,FL„34982 ,_
Phone:(772)462-2172 'N.M772)462-6443
Asbestos Notice to Contractor
April 26, 2017
ADAM SMITH BOBCAT SERVICE INC
ADAM SMITH
661 NE SPENCER ST "LE
Iry
JENSEN BEACH, FL 34957
RE: Building Permit Number 1704-0544
It is your responsibility to comply with the provisions of Section 469.003, Florida Statutes and to notify the Department
of Environmental Protection of any intentions to remove asbestos when applicable in accordance with state and federal
law.
Signature
Date
4/26/2017 10:23:13 AM