HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ++ n I OWL Date: Permit Number: 1 VI l ' O J 1 L
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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT-LOCATION:
Address: 1104 Midway Road, Fort Pierce, Florida
Legal Description: WHITE CITY BLK 40 LOTS 1 AND 2 AND N 10 FT VAC ALLEY ADJ ON S AND LOTS 10 TO 17 INCL
AND S 10 FT VAC ALLEY ADJ ON N AND S 15ST VAC CHARLOTTA ST ADJ ON N (0.90 AC) (or 2481-2295;2578-83)
Property Tax ID#. 3404-501-0224-000-3 Lot No.1,210 TO 17
Site Plan Name: Islamic Center of Fort Pierce Block No. 40
Project Name: Islamic Center of Fort Pierce
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ,
Selective demolition 0
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric Plumbing []Sprinklers 1:1 Generator F] Roof Roof pitch
Total Sq. Ft of Construction: 800 S . Ft.of First Floor:.800
Cost of Construction:$ 2.450.00 Utilities:Sewer E]Septic Building Height: one story
OWNER/LESSEE:._ CONTRACTOR:
NameAzaan Inc. Name: Randle Beckford
Address:805 South Virginia Avenue#16 Company: L.E.B.Demolition&Consulting Contractors, Inc.
City: Fort Pierce State:FL Address: 7 Harbour Isle Drive East
Zip Code: 34982 Fax: City: Fort Pierce State:FL
Phone No.772-361-2706 Zip Code: 34949 Fax: 772-461-2225
E-Mail:adelnefzi@yahoo.com Phone No. 772-461-4545
Fill in fee simple Title Holder on next page(if different E-Mail: iwreckn@aol.com
from the Owner listed above) State or County License: 26948
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 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
comm work or recording our Notice of Commencem
Z ��A
S
Signat' of Ow essee/Contractor as Agent for Owner Sign ontractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA / 7
COUNTY OF FLORIDA St LLI L I -e- COUNTY OF FLORIDAThe forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 15 day of Nov 20 LLAby this 151h day of NOVEMBER J20 by
2 cLr\C 1---Q 1lp-_k- 1-cj dC k:F_0 Gl
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature ofQJotary Public-State of Florida)
Personally Known OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. _ ._ ( all._._._. Commission No.
o. .M Csr E P HEBTr*R
®IRI®ERP NESTER
MY COMMISSION
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EXPIRES �?;t°•' EXPIRES August 25,2019
Revised 07/15/201`4,e=,. o s� ES '� 'zo19 .•,c�,a1e-I.`5a
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
November 10,2016
Islamic Center of Fort Pierce
1104 Midway Road
Ft.Pierce,FL
RE:1104 Midway Road,Ft.Pierce
Completed removal,hauling and disposal of 750 linear feet of window caulking.
Thank you,
74.
Kevin Klein
Owner
ClcannBaailding,Inc.*PO BOX 2211 Winter Park,FL 32790"Phone:407-478-o627*Fax:888-288-9335
FL Lic#s:CGC15i79o7,CJCii5418o&CMC1249946