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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO /MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �/ / Permit Number:
4_7- l RECEIVED NOY 172015
_
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: Tow�at tete-eed-E�#tine
PRQPOSRI 1'M1-1 ME T L©CATION: In 1
Address: Oce. ,-7 J#LS0 Dente, /9,�c4 �L- -3,'175-7
Legal Description: 14//, r,/// L1214 e 7',Ie ` Sof G e16). /70./ 6,w,%-IJ0 er 3W 7F
Property Tax ID#: y5-11-,?I0- 00Y7-000 - d Lot No. .70
Site Plan Name: 1i✓/),7/. Block No.
Project Name: 1®1 ,30
Setbacks Front Back: Right Side: Left Side:
D.ET tL�ED (5E iCR�iPI"ION ": r v ORlvu
77 AIS Po off,'/ Ao,bi e
C®.NSTR�L1CTl.®N I'N'FO,RMATI,®'N:
rtiona wor to e e Orme un er t is permit—check all that appy:1:1 Y
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric um ng Sprinklers Generator Roof
Total Sq. Ft of Construction: ;2 7 Sq. Ft.of First Floor: 17
Cost of Construction:$ /Goo,c o Utilities: L J Sewer 11 Septic Building Height:
ODUNER/LESSEE _..: .. C®'NITR1ACTO:R
.
Name Name:
Address: 233 6he,6ucf0 V1•• Company:
City: 64`t,,,Ile State: QA/ Address: 1, d/ Wil:
Zip Code: L dj ,r)pil Fax: City: JeAf ro I?e,-ie Stater.
Phone No. <75Y 1110 3763 Zip Code: IV57577 Fax: 772 Z32 2171
E-Mail: Phone No. 77 371T
Fill in fee simple Title Holder on next page(if different E-Mail: arf�vr�
from the Owner listed above) State or County License: GSC
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTA11
L CONSTRUCTI©N LIEN LAW IINF©RMATIMRS,
„
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:
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.
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-�. L V t 1 COUNTY OF
The forgoing instrumen was acknowledged before me The forgoing instrument was acknowledged before me
this�day of IO\ 20 NS by this 1A day of i►JC7J 20 AS by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi -State of Florid (Signature of Notary ublic-State of Florid
.. J IVENS 1
Personally Known QJd�P �r�lifil a �# Personally Known .,.� '�'-1OR Pcb✓ 8 �L#gnt�f,2s �� V
Type of Identifi_ w�Produced Type of Idehtificat!pp,,,P,rod�f�`p�Jy
A b( . `Vu
y Pu( Nola mm.ExP� #EE g58 pssa is ° ` ' omm• 0 EE 858
Commission A i. •,.'4M� mssion�S� )yo cy _ Commission, o, P ` missihNa11 �ry Assn.
t.1 ' .' r:. djhcoh9' ti'` '• Sc ohded(h(ou9
yu 9
Revised 071NY-014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
77
Piannn9.8Devel9pmentServices '. ASBESTOS NOTICE
;Building&{Code Regulation Divisloi►.;
•2300,Wiinia'Avenue;
Forf_Pierce,FL 34982'
Phone(772j462 2172 Fix`(772)462-6443
Asbestos Notice to Contractor
November 17, 2015
ADAM SMITH BOBCAT SERVICE INC
ADAM SMITH
661 NE SPENCER ST
JENSEN BEACH, FL 34957
FILE Copy
RE: Building Permit Number 1511-0277
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
Date
11/17/2015 9:49:05 AM