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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:_ _ Permit Number: s. 1 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 COMME!rcial Residential ��— PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION � � _ . .....� . ,, r Address: Z ��� 5 _ a-✓, ccr'I t va `. �✓. Legal Description: C ►S ej 1c 5/6 r/L Lo -3 L y c"t o F J:z<_ JZ k - L eSS 7hc.f A heti C-f SL.� eo.-0e_,-Caf 7 iZo0yisf` Sh (Z,;- c' -14-G 411 u eD Ft -t I'X2.c [lei Property Tax ID#: Z t, Z oo '-$ O Z " 00 O L/._ 00 L, 3 Lot No._3 Site Plan Name: /l� _ Block No. _ Project Name: Setbacks Front: _ Back: Right Side: Left Side: DETAILED DE5a, RIPTION OF WORK f4t.-"/1" CAC--ye Z� i}��n 24D v� If LI2 cirze-L. " IL.e..I QNSTRUCTION IN1=pRMATICIN. a M_.,, monawo to e er orme uncler this permit-check all tbat appy: E1HVAC Gas Tank Gas Piping JShutters Windows Doors Electric Plumbing Sprinklers E1 Generator I�Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ 2 c�OO, Utilities: DSewer []Septic Building Height: OWNER/LESSEE: I1,ONTRACTOR: Name_— _ Name: 0095-1- cc-1,1ct .Sec.,e Address:_ Company: City: State:— Address: Z I S'S S Zip Code: _ Fax: City:_A_/"'? C I f�'/ State: Phone No. Zip Code: -3 if cl ( ® Fax: 7 ) Z- Zfri 5_76,6 E-Mail:_ _ Phone No. 77 Z Z 6-1, S 76/a Fill in fee simple Title (Holder on next page ( if different E-Mail: ROIIda e'04S<<7 G7cefI/e-1 �trL'�cP .C,• from the Owner(listed above) State or County License: 1_-Z/3 e o/t/S-6 If value of construction is$2800 or more,a RECORDED Notice of Commencement is required. °SUPPLEMENTAL CbNSTRUCTION LIEN I_A`dV II' TORMATION:.__T. DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: _ — _ _ Name: Address: Address: City: _ _ State: _w 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 your Notice of Commencement. --- — ` s _Signature of Owner/Lessee/Agent Signature of Contractor/ icense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY 0F­i?:L-%C�- ; The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of_ _ , 20 _by this-W"`day of 20 LQ, by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida) Personally Known_ _OR Produced Identification— Personally Known, OR Produced Identification Type of Identification Produced Type of Identification Produced _ .�iA- a Int , Commission No._ (Seal) Commission :.�' -LINDA E MAG*?k' INIotAry Public-Stat o1 Florldsi — --_-- 4 IV Comm.EONS Oct 20-201 Revised 07/15/2014 n1� Cortpgit�bll I It 22140 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE: INITIALS ,4cr�rra► T DD CERTIFICATE OF LIABILITY INSURANCE 2XE .3/2o 6) THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES IVOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATIONIS WAIVED,subject to th terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer right;to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: AUTOMATIC DATA, PROCESSING INS AGCY PHONE FAX (A/C,No,Ex[): (AIC.No): 250717 P: F: E-MAIL ADDRESS: PO BOX 33015 INSURERS)AFFORDING COVERAGE NAICN SAN ANTONIO TX 78265 INSURER A: Twin City Fire Ins Co INSURED INSURER 8: INSURER C: COASTAL ELECTRICAL SERVICE INC INSURER D: .2155 SW GULL HARBOR LN INSURER E: :PALM CITY FL 34990 INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TIiIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT rO ALL TIE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TFPE OF INSURANCE ADDL SURR POLICYNUMBER P��D�FjF POLICYEAP LIMITS COMMERCIAL GENERAL LIABILITY OCCURRENCEY CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED a PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL S ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICYPRO ❑ LOC PRODUCTS-COMP/OP AGG c DJJ JECT OTHER: S AUTOMOBILE LIABILITY (Ea SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) g — HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ --r.EF RETENTION S WORKERS COAWENSA TION X PER OTH- .4NDEMPLOPERS'LL4RLLTTr STATUTE ER ANY PROP RIETOR/PARTNEIZUEXECUTIVEY/N E.L.EACH ACCIDENT $10(), 000 OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) ❑ N/A 76 WE(; JW5367 02/21/2016 02/21/2017 E.L.DISEASE-EAEMPLOYEE'10Qr 000 If yes,describe under E.L.DISEASE-POLICY LIMIT 1500, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHIRD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. Electrical work/installation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE SAINT LUCIE COUNTY FLORIDA DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CONTRACTOR LICENSING AUTHORIZED REPRESENTATIVE 2300 VIRGINIA AVE FORT PIERCE, FL 34982 ©1988-2014 ACORD CORPORATION.All rights res rved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Property Identification Site Address: 3333 S INDIAN RIVER DR Parcel ID: 2426-502-0004-000-3 Account#: 30716 Map ID: 24/26N Use Type: 0100 Zoning: RE-2 City/County: Saint Lucie County Ownership ' s ! ' Harold S Williams 3333 S Indian River Dr Fort Pierce,FL 34982 Legal Description ,. EINSEUS S/D N 1/2 OF LOT 3 LYG E OF FEC RR-LESS THAT ,E PART MPDAF:BEG AT SW COR LOT 7 RIO VISTA S/D RUN E ALG N LI OF SD NI/2 100 FT,TH S 20 DEG 58 NUN IOSEC E 153.41 FT,TH W ALG S LI OFSD N 1/2 608.34 FT TO E R/W FEC RR,TH N 24 DEG 25 MIN 00 SEC W 157.32 FT TO INT WITH N LI LOT 3,TH E ALG SD N LI 518.47 FT TO POB- Current Values Just/Market Value: $392,500 Total Areas Assessed Value: $323,338 Exemptions: $50,000 Finished/Under Air(SF): 4,263 Taxable Value: $273,338 Gross Area(SF): 5,033 Taxes for this parcel:SLC Tax Collector's Office Land Size(acres): 1.56 Download TRIM for this parcel:Download PDF© Land Size(SF): 67,890 This information is believed to be correct at this time but it is subject to change and is not warranted. ©Copyright 2016 Saint Lucie County Property Appraiser.All rights reserved. C'oastal ELECTRICALSERVICE ------------------ INC ------------------- 2155 SW Gull Harbor Lane Palm City Fl 34990 (772)286-5771 —Office (772) 286-5766 - Fax 1 L2- /� a EH Ov'k `4ZCvZ i1i1 nn D L cx `l �..� fwn (grv�u� ROCfS Page 1.