HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o Permit Number:
RECEP"I JUN 14 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 1/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
R',R' SED INPR®U'EMENT LDCAT ON:
Address: .1070/ S 0Ce9 h 91•.t W Te,1,ren A44 , 1—'L. 7!157
Legal Description: Veg;��/'e
Property Tax ID#: 510 - ON 7 -0010 ,2 Lot No. F.2ol
Site Plan Name: VeAhel f' Block No.
Project Name: ��O
Setbacks Front Back: Right Side: Left Side:
DETAIhED � ESS P l0N OF OR
Comple le Weivo/i`h'oi 2,�' s7' m ak/ P
CO`N51"0UCTIO'N IN�FOR�MAT'10N:
Additional work to be pertormeci under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
ng
Total Sq. Ft of Construction: / 7 Sq. Ft.of First Floor: 9
Cost of Construction: $ /700 Utilities: Ysewer _Septic Building Height:
OW�NER/LE�S�SE�E: CONTRACTOR:
Name S�a.-vn 11-1110*11d Name: 45�0�' L,
Address: 1066 /YL. 7-craze Vg6r Company: ,w r.-Mr• OJ4, svc "r)
City: jeopol; 8.e n-c4 State:FL. Address: Zd l /vef Zeeoee--
Zip Code: 3V,75-7 Fax: City: Sem rem '8P?tcCXi State: Al
Phone No. Zip Code: WZ67 Fax: 77Z ;23)•.2I9/
E-Mail: Phone No 7-7? 260 37/Jr
Fill in fee simple Title Holder on next page (if different E-Mail Cs llphr Srm"A4 i rC P yaho •Corr,
from the Owner listed above) State or County License CBC/Z S/!8/
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S' PP EIIJIEN AL CO'NaSI.T U T1'ON lRliE=N LAW IN ®R1ULAl'1®N .
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:
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 covenantsthat 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 recordi r Notice of Commencement.
L v
SignaVure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �k . 1.y�,�� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of , 20_XJ by this day of Soy%& 20A3 by
(Name of person acknowledging) (Name of person acknowledging
(Signature of Notary Public-State of Florida) (Signature of Notary P lic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identifi �---
Produced Produced L
,5 DEANNAMARIEGIVENS i'iIU2MY COMMISSION##GG�.1072023 ICommissiori No.t;�� o¢ ,. �g��MISS1eG6 21 AQ
0Zpommission No 1 IRNNota�pub cUldEoiwL XPIRES.QeWrc'b erwrite rya. a= d dShNNotry public -
ne
cF,r•
REVIEWS FRONT NING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
•Planning:'t-00000me0 rvicesp ASBESTOS NOTICE
Building&!P e,.Re0016 gn'Division°
2300 VerceirgiNaAyenue,
Fott Pi ,.F,L 34982.
O'one:(772i462 2'172 Fax:(772)462. ..
Asbestos Notice to Contractor
June 14, 2017
ADAM SMITH BOBCAT SERVICE INC
ADAM SMITH
661 NE SPENCER ST
JENSEN BEACH, FL 34957
FILE COPY
RE: Building Permit Number 1706-0306
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
-/7
Date
6/14/2017 1:52:01 PM