HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: D �G�- / -7 Permit Number: ncn-o3o5
RECEI1,r0 iUN 14 n17
� _, .. 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: Alm � f
o � ion
PR3OPOSED INPR'®VEMENT 1110CA1"I +:N:
Address: 10 70/ S Oce-,A Dr -At ?�2 y// �eiof-e4 ge.-4GL 3y9�7
Legal Description:_Ve.1/-&"-e ovf 0 / It-ell /02, F,241
Property Tax ID#: 0 - 00,2 F- 000 -8 Lot No. ��7
Site Plan Name: 1,6¢►1 h'^e Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET LED ® CSCR+IPTIO'N OF O'RK:
7�/ SJc I
Gond 7C/0r0om
CO'NSTRLICT ®''N I F0 + =ATI®'N:
Additional work to a per 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: 6.7c, Sq. Ft. of First Floor: 6 7 5
Cost of Construction: $ /Y00 Utilities: Sewer _Septic Building Height: A
®WNER/LE�SSE1 : C®'N RACTO'
Name A0 er-t Ila Name: z4wv M rl"
Address: 9y27 f 0/_ '07YDn / Pt, 6-3Company:)
City: J-e/9Sen &444 State: PZ. Address: 66/ /f•� S n«� S
Zip Code:341957-23/-d Fax: City: �eh �L
Jew ��c State:
Phone No. 5-16' O JVD-3//7 Zip Code: 3c�9`J 7 Fax: 77,2 23)
E-Mail: Phone No 772 27ZO 37/5
Fill in fee simple Title Holder on next page(if different E-Mail ti Cr H7.SM % ,"! ;-4 C_ � y400 ,C0-1
T
from the Owner listed above) State or County License _'T/9 5'
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
UPPLEMEINS ALCONSTRUCTON"N 1100 LAW INyF®'R�IULATkIJN:
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 covenants that may restrict or prohlbit'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
commencin work or recording ou otice of Commencement.
Signatu Owner/Les a/Contractor as gent for Owner Signatu of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sac • �-�G � COUNTY OF L Jc�e
The forgoing instrument was acknowledged before me The for oing inst ument was acknowledged before me
this day of JuW'� , 20� by thisAc
of JyY14k ,20�'J by
c�.Ay� 5 rn �� � �.d c�►y./�, S V�n.ti ��
(Name of person acknowledging) (Name of person acknowledging)
(Signature.of Notary P lic-State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification _ -0w- Type of Ide"I
=�'" `— L V.F NNA MARIE GIVENS
Produced t. - rjEANNA MARIE GIVENS
Produced=,:��`
;,:,.•
G 022023 _ GG 022023
7 MY COMMISSION#G ;F; r,
Commission No. + EXPIREJck§ her 16,2020 Commiss'ioTl; ?• mbecur;2' 2oIS I)
%; o? Bonded Thru Notary'Tublic Underwriters b(ic Underwn r
I '•;7 ...
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE 'MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
A0010g00010pm00ServlcesW_fi..rt ASBESTOS NOTICE
:Building.&;Code Regulation Diiiision,_
.:2300 VirginiaAvenue;
ForfiP.ierce,FL 34982:;
PK6ne;(77214622172 Fa)i:(772)462-6443
Asbestos Notice to Contractor
June 14, 2017
ADAM SMITH BOBCAT SERVICE INC
ADAM SMITH
661 NE SPENCER ST
JENSEN BEACH, FL 34957
FjL
RE: Building Permit Number 1706-0305
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
A/-
Date
6/14/2017 1:46:26 PM
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