HomeMy WebLinkAbout0504-0180 APPLICATION FOR BUILDING PERMITSECTION:
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DATE FILED: -L-1 -(3b \� 0�09 - 01
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PLAN REVIEW FEE: J RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE 8L FILLED IN TO BE A CEPTED
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C Gy ST. LUCIE COUNTY PUBLIC WORKS
co BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
'20R\OP FORT PIERCE, FL 34982-5652
772-462-1553
APPLICATION for BUILDING -PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS: ® Ne5 6L\)
S/D NAME: h`t 1CA, � 0SITE PLAN NAME`
PROPERTY TAX ID .#: Ljz�;o2 - so, OS-1 f o
LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT. `] 6. PAGE 7. BLOCK 8. LOT ���
BOOK 1� NO. �) f A-" I NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS.. •���
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: t BACK: RIGHT LEFT
®�
to �® SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ J� NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
ESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
��
13. DESCRIPTION OF PROPOSED USE:�s�`�
Mal #
14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1 st Floor:
16. VALUE OF CONSTRUCTION: $ 95,E
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 colAsistent 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
OWNER INFORMATION:
NAME: V)C A' Mes C C•1+.]�
ADDRESS: r %Vn9 bem-j oekoe
CITY: -,VWSTATE: e ZIP
PHONE (DAYTIME): {
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: _
PHONE (DAYTIME):
STATE:
ZIP
CONTRACTOR INFORMATION ST. of FL REG./CERT #: CW072cz1 ST. LUCIE COUNTY CERT #: j `0
BUSINESS NAME:
QUALIFIERS NAME: G'6 1
ADDRESS: �� dceA. � MU Qe_
CITY: STATE: t� ZIP�i
PHONE (DAYTIME): (. 1 ® I FAX NO. `22A s `�r
ARCHIT/ENGINEER:yye\/PO4:x% k . 2,
ADDRESS: 20 � S.4-0 , Po C—\- -s.) i ll E�k®\�4
CITY: JP51— STATE: ZIP -q�
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY: STATE: _ ZIP
MORTGAGE LENDER:
ADDRESS:
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.
CERTIFICATION:
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
STAN
COU
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.
SIGNATURE
The foregoing nsfrument was acknowledged
before me this day of AR rl t, 20 eS by _
who is,personally known to me or who
has produced -I�l� )" as identification.
� • I-l1 a • S1 •3�1 • c�
S nature of Notary
Type or Print Name of Notary
Notary Public Title
TURE
TE OF FLOKIDA
The foregoing instrument was acknowledged
before me this day oPnRr 1 , 206�_ , by
who is personally known to me
or who has produced -PD }- as identific Ion.
r-In— 6--SDO - Lo
Sign re of Notary
9-Dff c-+ n 7, se-ry 08-� �
Type of Print Name of Notary
Notary" Public Title
Commission Nitsr�r Beatriz Serrano Commission Number
Commission #DD228304 $eatriz Serrano
(seal) 5;. Expires: Jul 01, 2007 (seal) Commission #DD228394
Ex ices: Jul O1, 2007
, o �i;o Thru :a` p
Atlantis c BondCo., Inc. = 9' • ... • P� Bonded Thru
�OF fV,,'
0 Atlantic Bonding Co., Inc.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.