HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1Gd �rd�d3
RECEIVED JAN 28 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:2.S'OD 7_1ia c, Z J
Legal Description:_ /v e, Q^ Ks Zc_s -r-4-;e icq'f
PropertyTax ID#: _75(0-Ir- m/ o CPO / C' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Total Demolition of .s'F,
CONSTRUCTION INFORMATION:
Additional workto e er orme under this permit-check a appy:
HVAC �Gas Tank OGas Piping _Shutters Q Windows/Doors
0 Electric 0 Plumbing Sprinklers 0 Generator 0 Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 0 Utilities:[]Sewer 0Septic Building Height:
,OWNER/LESSEE, CONTRACTOR:
Nameflorida department of transportation Name: Clyde A Biston
Address:3400 W Commercial Blvd Company: Cross Environmental Services
City: Fort Lauerdale State: FL Address: PO Box 1299
Zip Code: 33309 Fax: City: Crystal Springs State:FL
Phone No.954-777-4242 Zip Code: Fax: 954-583-
E-Mail: Phone No. 954-583-9528
Fill in fee simple Title Holder on next page(if different E-Mail: jt@crossenv.com
from the Owner listed above) State or County License: CGC 062981
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: *x- Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: 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 thepermit 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.
119— Ae<" a S
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF BROWARD COUNTY OF BROWARD
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_46 day of '3,a,✓ 20,4 by this qday of :TW ,20 1IC by
Clyde A Biston 1 Clyde A Biston
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
MY
Pue", MICR L W.PICKER
Commission No. °`:R'PuB��� MICF1.9
MY COMM iFF012001 Commission No. $ t�jcicER
* * ,� * MYCi)�r�115SIUN+FF01 '!1
EXPIRES:June 22,2017
Banded Thri,BudgetNotary Services
EXPIRES:June 22,;1O i i
a F or FLu Ullaget Notary Services
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS