HomeMy WebLinkAboutBuilding Permit Application All APPLICAIBL IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
-. I D JAN 0 7 2016
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:
PRQ.POS.EDr NPROE, EN€T LQC.4T (k3N: . . „
Address: (i( vr,�
Legal Description:
Property Tax ID#: y A rJ �a o - X04 Lot No.
Site Plan Name: ^ 4 PIQZA Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILS!® DECK#I'�Tl®Nr(JF.U1/ R;K: ; le
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l/1 d• Per
CNrST RC1�ION 1NF®RMAT
Additional work to be pertormed under this permit-c ec a tat appy:
_Mechanical _Gas Tank. _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: /(jam® Sq. Ft. of First Floor:
Cost of Construction:$ ����, (/� Utilities: —Sewer _Septic Building Height:
OWNER%LES� E . � r k# C®N�TR`ACT®R; sF =t
Name r17 prerzll Name: e f QN
Address: Company: Crvy#7 r 00wi -
City: r>r 1.KCe e State: . Address: �.^
Zip Code: 3pqi9' Fax: City: t'e State:-EL
Phone No. �i 2 - 6 2 0*7 Zip Code: Fax:
E-Mail: ro teat wA Phone No 7-7
Fill in fee simple Title Holder on next page(if different E-Mail v
from the Owner listed above) State or County License (,A(±1 U_ owB_
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
BEST, L CONST UCTION Li''aN LAW MORMAT •N:
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 Not' Commencement may result in your paying twice for
improvements to your property. A Notice of Co cement must be recorded and posted on the jobsit
before the first inspection. If you int to ob I financing, consult with lende ran attorney before
commencin work or recording Notice ommencement.
Signature of n r/ essee/ r for as Ageni for Owner Signature on a r/Lic se H Ider
STATE OF FLORIDA S `- STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged b ore me
this 1 day of Zq� 20),q by this 1 day of_�Sq Y,, 20A by
M'%CA\m et W\ , 6,n 0. iTN"cgnae,\ �n r y�►
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida ) - (Signature of Notary Pu c-State of Florida)
Personally Known OR Produced Identification Personally Known OR r dura c@troiv
Type of Iden ' ication Type of Identification D b State o�', o
Produced L �— S `,�pRYPUe` Notary PubExPires Dec
t.1NP Otv�N°1 Florida Produced Lb -<» y EE 858761 c
_. P° Vic
-SiaDec 1g,20�5 =
Commission No. °tacY°m� I)s EEg5a761ssn Commission No. U ;FOFF� Bondeall��1ationi� `v._.,
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g,`�`. :My D0 mission# nat,�,taty� 'm.,,,,•
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IF
REVIEWS FRONT...... 1 ZONING SUPERVISOR PLANS VEGETATION, SEATURTLE MANGROVE
COUNTER` REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
,RECEIVED
DATE
COMPLETED
Rev. 7/2014
PlanningBDevelopmentServices ASBESTOS NOTICE
�B.uilding&:Code„Regulation`:Dlvisign
2300 VirglNa,Avenue,
ForEPlerce,.F.L,34982 _
Pfione(772j462 2172 Fax(TI2)462-6443
Asbestos Notice to Contractor
January 07, 2016
GROUP ONE CONSTRUCTION & DEV INC
MICHAEL J MIRANDA
10302 S FEDERAL HWY STE 164
PORT ST LUCIE, FL 34952
RE: Building Permit Number 1601-0100
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
o
Date
1/7/2016 1:22:47 PM