HomeMy WebLinkAboutApplication For Building Permit ( 2-14-2008 )DATE FILED: w� v � I�
PLAN REVIEW FEE: RECEIPT NO.: �: Ct� PERMIT NUMBER: a�� - 04 2
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
_ St. -Lucie County Building and Zoning
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. Z - o&U7 K .Zi�/2)iA.J,�ty�:'it At! Oe , 14 00194CW i FL 3Y?�2.
2. S/DNAME:• STTEPLANNAME: .T)R&d Xd*Jd0ifyC£
3. •ME,ER.511A :> 35I8" 2113 "000/ — CPO 0-3
4. LEGAL DESCRIPTION (attach extra sheets if necessary): N /O 6 GOVT GO T Z LrG rtOp l8
7-040xy. if 3 R,0w/`4' 41 6"ar Sr. Lce C I COGrwpry . 6L
5. PLAT 6. PAGE 7. BLOCK. 8. OT
BOOK I NO. NO. NO. CYO UT
9. PARCEL SIZE: (Q>SQ FT. LOT DIMENSIONS q t Z t VC /o it t
10. SGRIPTION QF ONSTRUCTION PROJECT OR WORK ACTIVITY:
x INI
Q&r k AJ ZJ Coyr ttu Gov .SZw/ r 054.^f L� a • irGuivc
ll. 1_1A FRO T: ?St BACK:' $CY-7S' RIGHT: IT. LEFT. Z• lr3
-" SIDE SIDE
12. TiaPE OICO1�iST CTION (Check all appropriate boxes)
[�Q NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
rRESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
] OTHER (SPECIFY)
13. PROPOSED USE: cS//VC�E /i�dtt/G✓ , W r4r_101
14. Sic} Et CONS I ION: (0 15. JJQ: t s ! Q g l
16.AiC� E,(3FCQNST UCTION:
The value of construction is used to determine the amount of permit fees to be assessed. St Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement most be submitted with this application.
SLCCDV Form No.: 001-02
CERTIFICATION:
c- L STATE:.ZIP
PIiO (AYTIIV) Q°`�'��'S3 email: S7eveaia%eeev1a4. vt
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
STATE:
ZIP
PHONE _(DAYTIME):
CONXRACTOR MFOi2MATIOU . ,,
ST. of FL REGJCERT #:s b s .• ST.LiL�iE COJNTY,CERT#:
�_, �-� . , �. a —,. �° ' •+ < '� ,.III ti i e� :e •'•,� 1: e e+ e.. . , �� „�,.,�. �'.;;
BUSINESS NAME-
QUALIFIEII:S`RAME:-
ADDRESS: ;
'
CITY: STATE: ZIP
PHONE (DAYTIME)- FAX NO. email:
ARCI3ININ>ER
BONDING COMPANY:
ADDRESS: .
CITY:
MORTGAGE LENDER:
ADDRESS.
CITY:
STATE: ..F L _.... ZIP
STATE:
STATE:
ZIP
ZIP
IMPORTANT NOTICE: When a permit is issued and'it;is.Aot-peeked up within 60 days after notification
it will be voided and returned to you by mail.
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
The -following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all -types), swimming pools, fences, walls, signs, screen .rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING. PERMIT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTEREST THAT IS SUBJECT TO ATTACHMENT: AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT.
OWNER'S AFFIDAVIT:
I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
STATE OF FLORIDA I ` ' I
COUNTY OF 't r`,v`
The foregoing insinstrumentyxas� acknowledged
efore me this (4day of by
-S+ief-1-6ri mbe:- , who is personally
kngwn oine,,gy)ho as piked cation.
ignature of -Notary
Type or Print Name of Not u�Y aygEATRIZ GOYCOCHEA
•
MY COMMISSION # DD 691439
Commission No... EXPIRES; July 2, 2011
• ,if ,?t c Bonded Thru Notary Pubft Unde wdtpA
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY -OF
The foregoing instrument
before me this _ day oV , 20__, by
who is personally
produced
as identification.
known to me or
of Notary
Type or Print Name of Notary
Commission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN__
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.