HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED
Date: D Permit Number: rqo t- vit3
PECEIV' D AUG 2 q 2016
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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: /D7)_ :-j- (j'ceam �r, - J_enfeh &f? -rGA , FI,• y77T7
Legal Description: liy eld•z DU'f q7 59- Gu Ci P /1 L 1- /tee
Property Tax ID#: ��'l/ - .�O11� 0 00 y- 000 -7 Lot No.
Site Plan Name: &rl GZlaz , Block No.
Project Name: 4f"2
Setbacks Front Back: Right Side: Left Side:
ditional work to be pertormed under this permit-checK all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
—Electric _Plumbing _Sprinklers _Generator _Roof
Total S Ft of Construction: � 9
Sq. �L Sq. Ft.of First Floor:
Cost of Construction:$ /'700.cv Utilities: <Sewer _Septic Building Height: �ICf
Name f�,`C:ct ' %/. ai+-'vr;+� Ff��cr Name: vol i
Address: d, 600_ Company: r'� �� ✓�• i'�c•
City:��%� ,h d��� State:V Address: zoo ,SDe h car
Zip Code: �'Z$,?j Fax: City: Teti IFc eiGA State:FG-
Phone No. V y11/-7I NI Zip Code: .3 y 7?7 Fax: 772 X32 /q/
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail e&CL/y7 .5:1h
from the Owner listed above) State or County License c::5,6 G
if value of construction is 2500 or.more,a RECORDED Notice of Commencement is required.
MR
DESIGNER/ENQJN _Not Applicable MORTGAGE COMPANY: _MON-40"Applicable
Name: Z - 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 you intend to obtain financing, consult with lender or an attorney before
commencing work px-,recording your,-Notice of Commencement.
Signa o Owner/Lessee/Agent Signature of Contractor/L cense Folder
STATE OF FLO I�A STATE OF FLORIDA
COUNTY OF COUNTY OF S�'• LUee'Z
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisM day ofd V 2QkG by this c' day of 201fo by
yN e,-m N
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub c-State of Florida) (Signature of Nota ublic-State of Florida)
Personally Known F�=ORyProduced Id@pXjffm fiNs Personally Known ;Q Produced��legt# sp�uoro�i
Type of ldeni<ifcation Ct Type of Identifcatio
'"tea : Notary Public State of Dila ��a Notary Public State of Florida
Produced L L,,' •'`:`"
'&J.' omm.Expires Dec 16,2016 produced LL y . M Comm.Expires Dec 16,2016
:° L'•`.o Commission#EE 858761 ; ='= commission#EE 858761
Commission No. F 8oc($eg ,Natio tarry Assn., Commission No. �� �(S�?�1 _
`�1 �s ,` Bonded Thr onal Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE '
RECEIVED
DATE .
COMPLETED
ev.
mannind&Development Services ASBESTOS NOTICE
13uii,ding&Cade Rcgulabon Division,
2300 Virginia Avenue
Fort Pierce,FL;,34982-
Phone:(7721462-2172 Fax:(772)462-6443
Asbestos Notice to Contractor
August 24, 2016
ADAM SMITH BOBCAT SERVICE INC FILE Cnpy
ADAM SMITH
661 NE SPENCER ST
JENSEN BEACH, FL 34957
RE: Building Permit Number 1608-0483
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
8/24/2016 2:56:40 PM