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HomeMy WebLinkAboutApplication For Building Permit ( 8-22-2006 )CERTIFICATION: C/ OWNER INFORMATION NAME: GT7r,-4-) 11XX1 ism lv ADDRES & 8I -57 . .CITY: iCI — cam% STATE:ZIP' < �- PHONE (DAYTIME): / �����5�3 email: 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): C__) CONTRACTOR- INFORMATION ST. of FL REG./CERT #: BUSINESS NAME: 51P /'_7 QUALIFIERS NAME:A� G ADDRESS: ST.'LUCIE COUNTY,•.CERT #: S. CITY: _ STATE: ZIP � PHONE (DAYTIME): FAX NO —7 'email: ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: STATE:_ : ZIP STATE: ZIP Q ADDRESS: CITY: STATE: ZIP IMPORTANT NOTICE: When a permit is issued and it is not picked 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 an oning. CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE. STATE OF FLORIDA COUNTY OF Sf-LU The foregoing insent wAs acknowledged before me this la_y of 2Qb(6 by .'w'ho4s personally m known to e or who has nroducecL Type or Print Name of N •iap;iti;. LISA W. CAISSE MY COMMISSION # DD310215 �,A. EXPIRES: May 19,2008 Commission No. F: ; anded Thru Notary Public Underwriters STATE OF FLORI>L� e r � COUNTY OF ��- The foregoing i ment w s acknowledged be ore me Ws 1may of , 200 ( by • }�, S whoA personally known to me or who has produced FL D ► \T-t r5. id ntification. ature of ry Type or Print N— �N� +� r�------- coca....... LISA W. CAISSE MY COMMISSIOQN # DDS10215 Commission EX9a101ay 19.2008 'TIViii'F: � Bonded Thru Not Public Underwriters 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. at _ _ _ 1"'• - G' - »- v ,s . h �Y. .\ a '�'-t<1'�3L- '_.��u "i,.-�"'y." �-e�m' a,'m�78'� F - n`��'"�,r°• 'R'�.�2 rTrs.�•w v `%-e}? �-�rF'�+c 9` � 'Fw-.� "'-c-' :} r '-T�- 5° '€+FS e- -�?, �.t �''+'� a. .G, T,�✓ci e;� .+y � c.'i £4... � �;' y'C �•� ,�y�.. ��`;�++•; -' �? x .+$w��. � 1' '',r`.�. x" -�" �. "�?r�``�,>�•;3 ..7� ,f''•°�.�.a;- d :>:..�;-a i • I • • LOT OF •0) • UIRED OVED }yY,'!'f§A--sFq` •�$to, {Fc�... .•ar.-',.+:• f Z 4 ,i.c..,U �� i'.,,�^ z"�,a.<i.a,.; . .i }4-F 9�y- F ;.3- .: ... -.: a?v-,h•^4,�,x...ff-2v-•2 ''..-� a.t,,,� ;-3,t i- '•e�•. 7i' z•. ,�� ; n • -.,� .•. eF-�•� vP G�-'•' . ���'��' ��� . '' y!` a nt•.-. ti. -S Js�X.' 'z ,K-�' ,F r s: S.'� S ''.x2' 4w�'L__ T'' Y,{- C"�+ryi .3' FRSN �J`kf.-';...'i i ,�.t5•'5ta% �wpra4-tiP'< `.9•15,'N'4W ' S° '�-�1C 't5,,•., "J P ,- .a-� .1• 31fir2( pi s .z= -t 'Szt�, -> 'x ,t `� o. f;- ki -•(. {1� ' � ��a'F '�i' � _` -�. �, *"� � z""�`�--�" ,r �wc, ��,,� �g��','y"�'s _ , . I I• VARIANCF IMPACT FEE IMPACT REPORT PUBLIC BID HABITABLEI• CODE IMPACTFEE AREA ..I• i Sir IMPACT FEE -IMPACTFEE DUE �SCHOOL TOTAL IMPACT FEE SCHOOL 5 kMISC •• r FEE TOTAL.• rTOTAL ADDITIONAL PERMITS REQUIRED lofALL 'FEES �i. ,. 'l: �*".� •.y•�""'{?•:".. -fr�i+�•�C rcu�s�-,.c.''.rojFKE t�h c't-/.. �„'i,�4:r-ate• yu i'tii ,^s'srw .ta 45.5'.k-.iS - 4`4..? i'.A' 'sz^'. ,,4� •nT. .TJy"-t�N'.6.,�oi `,. '^:1i''T-',�3='+F--�`.3•- .. yr v. f � � -„7" �-- ��•eels-'•..�iw�d'��T'S'.rwT"na � � , .."7A.'`,�a';'5'e�_--p�..: < • . • ... E$, S � .'�. �Y--r` �.-•.." �"' 'i�'-�^ i `'� f •�J"�`rr ''� rla• DATE FILED: Qr Cep PLAN REVIEW FEE: /,NT-L120 RECEIPT NO.: 4� PERMIT NUMBER: O �O� ' CONCURRENCY FEE: 4W RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED _ St. -Lucie County. Building and.Zoning - 2300 Virginia Avenue ��OR10p`• Ft. Pierce, FL 34982-5652 Z._ 772-462-1553 9/it a<< ueLx)4_ . PPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: -7 9 d % 5 ZFD A—esl 2. S/D NAME: SITE PLAN NAME: Pjew—& K.l&C . $ 3. PROPERTY TAX ID #: 3 Sl S �24 3 O©O i ' -- O©O ^ 3 V 4_ LEGAL DESCRIPTION (attach extra sheets if necessary): /66� r -9 5. PLAT 6. PAGE T: BLOCK ' ° 3 8. ' LOT } .. BOOK NO_ _ 2 _.NO: : ��; '� � � � NO; U � 2 9. PARCEL SITE ACRE SQ FT, LOT DIMENSIONS 7tn2 (X©y ' �2 X 1 15'w 10. 1 DESCRIPTI,ON:OF CONSTRUCTION PROJECT OR WORK A ITY:_ `� / 3 D i�lG 11. SETBACKS (ACTUAL) _FRONT- BACK:.- RIGHT: `LEF.T_ ' SIDE -SIDE 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION RESIDENTIAL [ J COMMERCIAL [ .] INDUSTRIAL ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 14. Sq. FtJCONSTRUCTION: 15. Sq. Ft. 1st Floor: 16.. VALUE OF CONSTRUCTION: $ 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 must be submitted with this application_ SLCCDV Form No.: 001-02