HomeMy WebLinkAboutAPPLICATION FOR PERMITOct 01 08 11:32a
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LOT OF REC
LOT OF REC
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After 111990
REQUIRED
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PERMIT
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VARIANCE FEE
SPECIFY yiECHANIC OOF NON -CONFORMING MISCELLANEOUS U
SOBS ELECTRIC GAS LOT OF RECORD S S �'
REQUIRED PLUMBING FEES
DATE SENT TO ADDRESSLITG: _� 1
I
REVIEWS FRONT IZONING SUPERVISOR PLANS VEGETATION SEA TURTLE A4A�>iGROVE
[YlT`NTF_R REVEWW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
Oct 01 08 11:30a p.1
DATE FILED:
PLAN REVIEW FEE: . 00 RECEIPT NO.: PERMIT N-UMBER: u/y
CONCURRENCY FEE: RECEIPT NO.: CERT, CAP. NO.:
ALL O M�USTBE COMPLETE & FILLED IN TO BE ACCEPTED
lf
y St. Lucie County Building and Zoning
AWNED 2300 Virginia Avenue r
OR!Ft Pierce, PL 34982 5652.�o�-�
Lay 772-462-1553 -
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
�03ECT INFORIVIATION
1. LOCATiON/SITE ADDRESS: 2 5!±2 1'2 0
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #: !!�e-Z(q z — ` // — a 0 ®
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
JO 7-7-74 Ce4 6—=�
5. PLAT BOOK O¢Z 6. PAGE NO. /U 7. BLOCK NO. A14 S. LOT NO.
r7oi-J / �y /AJJ SN P 37 S j2i�3 r-,/Se E
— —t] P-AR-(—RT-477F-1-A.('_R-F-_S/SCl_F_'I' 1 • /� � T .(�T i7TMRNCTnNS � / Uv � � �C7
, 10.
I
12.
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13.
14.
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
SETBACKS (ACTUAL) FRONT:Z-,e2lJ BACK- G C-3 RIGHT SIDE:"'`"" LEFT SIDE:
TYPE F CONSTRUCTION' (Check all appropriaoe boxes)
[ NEW CONSTRUCTION C l EXPANSIONIADDITION [ ] INTERIOR RENOVATION
[ } RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ } OTHER (SPECIFY)
DESCRIPTTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR
16. VALUE OF CONSTRUCTION: $ - '5' 99
The value of construction is used to determine the amount of permit flees 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 sitm7ar types of construction activities. If the value is MOO or more. a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
Oct 01 08 11,31a
OWNER INFORMATION
NAME: � ! 7-I4F X Z' PfP �
ADDRESS: 0 ," ry c7f-- C--i . v 1--
01�—
CITY; / Sa Ce STATE: ��-
PHONE (DAYTIME): 0 o &ff - Email:,- Jim-P-
p.3
IF THE FEE SIMPLE TTf BOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIWLE TITLEHOLDER-. SAME f1 S 'Q�a ✓�
ADDRESS:
CITY:
PHONE MAYTIME): (._)
CONTRACTOR INFORMATION
STATE:
F7E-
ST. of FL REG.CERT k �- C �= a' G ST. LUCIE COUNTY CERT M
BUSINESS NANM: CO n�' S �l2CJ�i LO r:i 1 ^/ r -
QUALIFIERS NAME: `
(
ADDRESS: 4f3 70 gYr yLA �C��Z S%- J
H
CITY- 14 /r4 ytg/ STATE: /= L ZIP:
PHONE (DAYTIME): FAX Nca2S\ "?L�!"�Sr%S�Email: V ✓ G® i/�. �7�5'i'
ARCEN/ENGINEER: [siv.O
ADDRESS
CITY:
PHONE (DAYTIME): (1
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER -
ADDRESS:
CITY:
Z ef)v
STATE: ZIP:
STATE:
STATE:
FP•
Ar
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 6. 0 days after notification
it will be voided and returned to you by mail.
Obt 01 08 11:31 a - 2
P•
This applic::iion is hemby made m obrain a permit to do the -,vorl<. and insiallat1UE1S riS itkl+l illCii, ar+d tv C�Fain a t@rLl?I�B:� Of CaD3Citj,
if applicable, for the permuted •„cr1:. I certify Lhnt is work or installation has cornmariced prim t+� the i,suance 01, a pe,-rnit and that all
weirk �viil he perEorned to meet the s:ai Ya-ds of all fawn rz�*ulsti:lg con strue*.ion in t<`Fis jurisdictici+;. I tutderstanJ that separate permits
may bu cequired for :.LF,.CTR,C_4-L, PL.U�'FBD\G, SIGNS, WELLS. FOOLS, FlR-\aC_'FS, R0I.1,FR-9, Iir-IATERS, TANKS,
liltii) AiiZ CfZiti'DITIONFRS,17rC.. nut orftonvise in cludcu v:'.th this building permic applic:aiiuu.
St. Lurie County rrakes no representation that its grantin- of a pertnii wiii authorize the permit Holier to bttild the subject structure
which is in conflict -ith my applicable. Hoiritoweer Association rubs, bylaws or any covenants [hat tnuy rrataict or prohibit suc'>,
sin.icturr._ Please consrlt wirh vOur Hoireowrer's Association and revie x' your deed for airy rastr-ictions vrL-ich may apply.
The for?owing building permit applications are_ e:xatrpi frorn undergoing a ru:l cuucuircncy review: roon, ziddirions. accessory
structures (ii%I -Ypcs), sivur lntii.� Pao"* fences, "ally. Sighs, Screen roonis, utility substa i:ln-A &Q. accessory 1f5eS t0 3nother non.
residential use.
N077CE TO OWNER: 1 AILU'11 tE f13 RF-C 0 R D A INOTICE OF C0TVjMFJNN0- vlE1 i 1VIAY RESULT I:: Y^UT,
PAY.NG T\VICE FOR IA•IYKOVENIE.t1TS TO YOUR PROPERTY. IF YOUTII'vTEND TO
UBTKl1 I-INAIXC:L-NG, SULT ,V T I i YOUR LE2dDER' ()R AIN ATTOR,KF.Y BF -FORE
12ECO✓I`;:J YOUF; C)TICF OFF CO ,yIE1.
P.
NOTICE TO APPLICANT: AS THE APPLIC LN T FOR T tilS BUILDING PERMIT, IF rl' IS NOT YOUR RIGHT. TITI-p-
AND INTEREST THAT IS SUBJECT TOATTACHMENT; AS A CONDITION OF THIS
PERDd'1T YOU PROIVIISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHA=-
OWNER'S AFFIDAVIT:
I cerdfy that all the foregoing information is accmzte at work will be done in compliance
with all applicable laws regulating construction zo
OWNER OR CONTRACTOR SIGNATURE CONTRAC110R. SIGNA
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was aelmewIedged before
me this day of 20
by
who is personally known or has produced
as identificatiom
Signature of Notary
Commission No. (Seat)
STATE OF FLORIDA
COUNTY OF M I P ,,4 i
The foregoing insu-un mt was acknowledged before
me this day of
by
who is personalty known has produced
f OU S AI_VAREZ VEGA
- f Florid
im
Signattre of Notary _« ,c.y Commission Expires Jun 12; 2
p o ission # DD 528363
No. B
Commission v National Notary As
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE D4UST BE NOTARIZED. 1F APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERMUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFMAVIT WILL BE REQUIRED FOR ALL OWNEWBUILDER APPLICANTS.
For specific instructions see appropriate perinit checklist