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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: 12-7-2016 Permit Number:
RECEIVED
-s Building Permit Application FEB 0 3 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Building
a
PROPOSED IMPROVEMENT LO.CATiON:
Address: S. Brocksmith Road Fort Pierce 34945 I -IC10 S f-0CV-6rn `V/P Li 5
Legal Description: HAYS SUBDIVISION (PB 71-12) LOT 2 (11.105 AC-483,734 SF) (OR 3892-858)
Property Tax ID#: 2317-500-0003-000-5 Lot No.2
Site Plan Name: Lot 2 Hays Subdivision Block No.
Project Name: Hays Residence
Setbacks Front 580' Back: 226',Zb Right Side: 188' . Left Side: 164'_, 0
DETAhLED DESCRIRTIO;N°OF WORK:
New 3,500sf residence. Construction to be CBS with wood truss and metal roofing system.
CONSTRUCTION,INFORMATION: .
Additional work to e nertormed under this permit-check all that apply:
ZHVAC Gas Tank Gas Piping 7 Shutters Windows/Doors
❑✓—Electric [z Plumbing Sprinklers F]Generator Roof 2�6 Roof pitch
Total Sq. Ft of Construction: 3,551 S Ft.of First Floor: 3,551
Cost of Construction:$ 290,000 Utilities:Sewer[21 Septic Building Height: 20'
OWNER/LESSEE: : ' , CONTRACTOR:
Name Peter B Hays Jr&Jody Hays Name: Jared.AAedtrr-g7 cth"I
Address:1520 S. Brocksmith Rd Company: Cole Construction Services, LLC
City: Fort Pierce State:FL Address: 497.S. Brocksmith Road
Zip Code: 34945 Fax: City: Fort Pierce State:FL
Phone No.772-201-1762 Zip Code: 34945 Fax:
E-Mail:phays88@aol.com Phone No. 772-519-0558
Fill in fee simple Title Holder on next page(if different E-Mail: coleconstruction@hotmail.com
from the Owner listed above) State or County License: cgc1520537
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LfEN LAW INFORMATION "
DESIGNER/ENGINEER:_ j x Not Applicable MORTGAGE COMPANY: TBD Not Applicable
Name: Cook&Menard Architecture Name:
Address:806 oeiawareAve Address:
City: Ft.Pierce State: FL City: State:
Zip: 34950 Phone: 772-460-7751 Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X 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 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 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.
Z 4-/'y s
Signat re o Owner/L sse Contractor as Agent for Owner Signature f Contractor/License older
STATE OF FLORIDA •�L�� OY FLORIDA �� • � /j/� (
COUNTY OF COUNT OF
The oing instr ent w s ack owledged,b,,efore me Th forgoing instr/��ment w�as/ac owledged before me
this M day of �� # 20 Eby thi day of Ili(Rrn 20 lU by
Q.C�..P,� �. (-�a�S ��• (,�(Q �'l � fie.
(N a erson ackno dgi g) (Name of rson acknowle in
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(Sig re of Nota Publi -State of rlorida) (Signat f Notary Puublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission N ea�a�� FANY L.S AR qDOTIFFANY L.SGARAAARpQ ; ; , : Notary Pubtic=Siite.ot ly Comm;Ekplres'S,ep 2,'2017 � My omm. xp ntRevised 07/1 2, a .,?;o td Commlesston s'FF SO
Commission vy'FF,50588
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