HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .5 S Permit Number: S d 5 031 �o
xY w r.4 RECEIVED MAY 2 6 206
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: To Select from dropbox, click arrow at the end of line
Pk'
POSEb.1, IRR.OUEMLNT LOCATION
Address: SM-1 BIPC1k -DIR\VlC- II` R.CE,
Legal Description: '
Property Tax ID#: (10D P3 —01"1(a ^CXo ^ Lot No. �1�
Site Plan Name: b,p c 'r bA 1�G Block No. _
Project Name: CIRCW 1 -b!tft-A G
Setbacks Front Back: Right Side: Left Side:
I?ETAlLED DESCRIPTION OF WORK
IRemi,vaIVIC'LL
rewn�c�Q on�
CON
STRUCTION:INFOR(VIATION
Additional work toe e orme under this permit—c ec a appy:
HVAC E]Gas Tank ❑Gas Piping Shutters Q Windows/Doors
Electric 0 Plumbing OSprinklers OGenerator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 1, 000. 00 Utilities:cn Sewer F]Septic Building Height:
OWNER/LESSEE - CONTRACTOR:: '
w . .
Namelj f- Name: `In�, ,AG�IvS _
Address: Company:s,Q6 .\n cz\ s (�.n sa-t u r+,a —
City:�)��h1r�n� D e State:_ Address:bno) D IPn r A0_r Ave-,
Zip Code: Fax: City:'L Qy_ ca_ $-C. State:
Phone No. Zip Code: 3 q9_'M Fax: '17L(}b(®61+11)
E-Mail: Phone No. —111l '992 X334
Fill in fee simple Title Holder on next page(if different E-Mail: 5'YVASacDV:;b Alc>\ 2 LbYV3
from the Owner listed above) State or County License: C 64, Db a IA,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ of Applicable MORTGAGE COMPANY: _-'lgot Applicable
Name: Name: n
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE,TITLE HOLDER: Not Applicable BONDING COMPANY: L lTot Applicable
Name: Name:
Address: SI 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.
s
K V__' .
_
Sig, r of Owner L ssee/Agent Signatur f Contractor L' ns11 e Holder
STATE F FLOR D STATEWF FLORA
COUNTY OF �T LU C �L COUNTY OF Sfi L U C 1 C
The forgoing instru ent was acknowledgedpefore me The forgoing instrument was acknowledged before me
this day of 201by this day of Ir
20 S by
o v1 S Gt COS L e k w '\4LC.a
Sqsl _ r'P 'C'P l"C ryl t l S 1.- I'QA VAD_L-L(+— . ( AAL-4- l
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known V OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. I =22= %- . -71
SUSIETMMULTk's SUSIETETREAULT
►; :r_ MY COMMISSION#EE 1
2: :+- MY COMMISSION#EE 125556
•llf; `Q Bonded Thru Notapry PubecrUndewhr3 "'ki,,;; Bonded Thru Not ESTS-ry Publc Urern or wffw le s
Revised 07/15/2014
,y r`
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
john jacobs construction 772-466-6491 p.1
-�
MIX a- 5�
A—%K-STOS NOTICE
.ti3ulldir�� .
Asbest Notice to Contractor
May 26,2015 �®
JOHN JACOBS CONSTRUCTION fNC
JACOBS JOHN M
4701 OLEANDER AVE
FT PIERCE, FL 34963
RE: Building Permit Number . 1505-0376
It is your responsibility to comply with the provis ons of Section 469403, F i r r}a 8191ulos and to notify the Department
of Environmental Protection of any intentions to remove asbestos when ai; d :able in accordance with state and federal
law.
4
+cure
s-�
Date
512612015 10:38:48 AM