HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT1
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DATE FILED: Ka-��'tl W,,
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: C�
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
DINTOBEACCEPTED
MlI T BE COMPLETE 8t FILLS
ALL INFO S
c�E o ST. LUCIE COUNTY PUBLIC WORKS
ti� BUILDING & ZONING DEPARTMENT'
2300 VIRGINIA AVENUE
�OR10Q' FORT PIERCE, FL 34982-5652
561462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
'7 53 (0 & Us I PROJECT INFORMATION
LOCATION/SITE ADDRESS: NE Corner of US 1 and Prima Vista Blvd.
2. S/D NAME: SITE PLAN NAME: prima Vista Crossing ,
3. PROPERTY TAX ID#: 3422-801-0001-000/1 and 3422-410-0000-000/4�
4. LEGAL DESCRIPTION (attach extra sheets if necessary): see attached
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
- 0. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: Retail b uldout -�` _ `
11. SETBACKS (ACTUAL) FRONT: BACK: ,. r N �, _ " - RIGHT LEFT
OIL
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL . [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: Retail Store UNIT 104
14. Sq. FUCONSTRUCTION: 15. Sq. Ft. 1 st Floor.
16. VALUE OF CONSTRUCTION: $ -
The value of eonstrucdbn Is used to determine the amount of permit fees to be assessed. St Lude County reserves the dot to question and/or modify thi
Indicated value of oonstrucdon if it Is demonstrated that the s pinged fgires ar+e,not c6ft6tent with similar types of consbudim actMdes..ilf glg.value is $?W
or more, a RECORDED Notice of Commenciment must be submitted with this applicadan. i ;
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SLCCDV Form No.: 001-02
CERTIFICATION:
OWNER INFORMATION:
-; AME: Crescent Resources, LLC 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
ADDRESS: 400 S. Tryon Street 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,
CITY. Cb ra�ttp STATE: NC Lp 28201-1003 TANKS, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
PHONE (DAYTIME): (704-) 373-5843
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non -
BELOW. residential use.
FEE SIMPLE TITLEHOLDER: same as above
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
ADDRESS: _ TWICE FOR IMPROVEMENTS :TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
CITY: FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
STATE: ZIP YOUR NOTICE OF COMMENCEMENT.
PHONE (DAYTIME): 1 )
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
CONTRACTOR INFORMATION PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN
LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
ST.-of FL REGJCERT #: 033026 ST. LUCIE COUNTY CERT #:
BUSINESS NAME: Keene Construction Co. of Central Florida, Inc. _ OWNER'S AF IDAVIT: I certify that all the foregoing information is acc to and that all work -will be done in compliance
QUALIFIERS NAME: Ga=7 T. KeenA with all applicable laws regulating constru and zonin
ADDRESS: 1400 Hope Road
---CITY-- - - - - - -- -- - - Maitland - ' - --- -- STATE: ' -- - �p 32751 - - - -
OWNER/ ONTRACTOR SIGNATURE CON CTOR SIGNATURE '
PHONE (DAYTIME):' (407 ) 740-6116 FAX NO. 407-539-3468
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF oyanga COUNTY OFnranrrge
ARCHIT/ENGINEER: Tag iarini Architects
ADDRESS: �'` 5720 Inter -bay Blvd. The foregoing instrument was acknowledged The foregoing instrument was acknowledged
tfefore me this I day of 20D2,, by wry before me this A— day,of , 20 02 by
clnr: Tampa STATE: FL ZIP 33611 ' =,newho is personally kno to me or who Gary L Keene ,who is personal known to me
has produced n / a as identification' or who has produced n a as identification.
PHONE (DAYTIME): (813) 805-7838 I
Bono*111// Is ICY I � \\\`����f111U11frt(�yi
Signature of Notary �"N yre •••••••1fo Signature of Notary
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n/a _,� . �o�Ssa �o A9 . .OMISSION.o ���'
BONDING COMPANY: Sheri L. Bonotto _ :� �Q N. Sheri L. Bonotto �a��18'?0o O9�
ADDRESS: Type or Print Name of Notary E * : a * ` Type of Print Name of Nota =* �. �''
CITY: YP rY _ YP
STATE: �p #CCB01355 a Q` yO,% #C:C801355
Notary Public Title %;9� • ;�BFayn`�� ;' `���� Notary Public Title
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MORTGAGE LENDER: n/a Commission Number Commission Number
ADDRESS: (seal) (seal)
CITY: - STATE: ZIP ;
NOTE: TWO (2) SIGNATURES:ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED'
IMPORTANT `NOTICE: + ` r " -~ ' ` �x ' r ""s` a `' - IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEFj/BUILDEI' THE OWNER MUST PERSONALLY APPEAR
P P : P withiln •... _.=s,:: a s
When- a ermit. Is issued and it- hi not_ icked �u 60 day TO SIGN THIS APPLICATION IN THE OFFICE LISTED ORTHE FRONT OF THIS APPLICATION. . _ ..
after notification it will be old and returned to you by mall.'-