HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c1
Date: \4 1 S Permit Number:
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-p SEP
2015
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:
Address: 10 5-- S C7C r.4Vi
Legal Description:
Property Tax ID#: 1-6 —5D 1 02- G Z —® 00/3 Lot No. /V/
Site Plan Name: // __ Block No.
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Project Name: L A:D'C/
Setbacks Front Back: Right Side: Left Side:
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Additionalworkto a performedunder this permit-c ec
a 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:
/000, 00
Cost of Construction:$ [ 000, 0 0 Utilities: _Sewer _Septic Building Height:
OWN
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{J;l1lR/LESS �, ,n CONTRACTOR z N
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Name_ , , Q1 //1 L,d 1 G? Name:
Address: ONS_/() 0:t+k f3&tZ Company:
City: S�ULAf L State:_L Address:
Zip Code: 31/7 q1-/ Fax: City: State:
Phone No. '99 (> 2-0 Zip Code: Fax:
E-Mail:_ /?omax' U-A - tiCf- Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
,Im.
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 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 yoy intend to obtain financing, consult with lender or an attorney before
commencing work or recordingNour Notice of Commencement.
n
SVhature of Own r/ see/Agent Signature of'Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SSC'. Luc'\- , COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this XS day of .20 .5 by this day of 20_ by
Orn J 0.A
(Name of person acknowledgin ) (Name of person acknowledging)
Y
(Signature of Notary Publ -State of Floridao ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Idaro Baa Personally Known OR Produced Identification
Type of Identification DEPNNP S 16 20� Type of Identification
Produced t' L °b\�° .\�e50e a58�6� ° Produced
P �\a°\any P5 '
Commission No.� Myr A�9) N2\0 Commission No. (Seal),
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.;;„110;,``,,
REVIEWS FRO ONING 'SUPERVISOR PLANS' VEGETATION SEA TURTLE MANGROVE
COUNT REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
le—v-. 712-014
t?anntngBDevetopmenfsevtces ASBESTOS NOTICE TO OWNER/BUILDER
8utding&Code,Regula4on_Divlsion:
r,Z300 Virginia;Avenue;
Fort==PtercetFL 34982,`
Phone(772)462 2172 ,Fax(772)462-6443
September 16, 2015 FILE CC)
PY
ROMUALD A PRYPUTNIEWICZ
1785 NW Harbor PL
Stuart, FL 34994
RE: Building Permit Number 1509-0286
Disclosure Statement: State law requires asbestos abatement to be done by licensed contractors. You have applied for
a permit under an exemption to that law. The exemption allows you as the owner of your property to act as you own
asbestos abatement contractor even though you do no have a license. You must supervise the construction yourself.
You may move, remove, or dispose of asbestos containing materials on a residential building where you occupy the
building and the building is not for sale or lease or the building is a farm outbuilding on your property. If you sell or lease
such building within one year after the asbestos abatement is complete the law will presume that you intended to sell or
lease the property at the time the work was done which is a violation of this exemption. You may not hire an unlicensed
person as your contractor. Your work must be done according to all local state and federal laws and regulations which
apply to asbestos abatement projects. It is your responsibility to notify the Department of Environmental Protection of
your intention to remove asbestos. It is your responsibility to make sure that the people employed by you have licenses
required by state law and by county or municipal licensing ordinances.
ner Signature& Date
9/16/2015 2:16:39 PM