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HomeMy WebLinkAbout0801-0392 APPLICATION FOR BUILDING PERMIT�. t. jc♦^ �400 W • + • s>`HJ`4 '4 2 ..�5 J �9 1- YF°"n3 Y' S`e",. M1"� :C 4'}.,c,.! t• f 1 `�. .Y t k ...Y '-'sw. k1'.s•^• "'a4 1 L Y' .. F iti E ci',.,5 £^,. a ._..1.a..�v,.<_-_. 't •G _`€+'p x _ l t Y%..e�' S .. i }r.- Yi•] „1'"j =L+� _ .1 i ! Y"% i :..' tz se •{. r. 1 - i t+y;,.., •v �'i .S 1.1t w.S.;_.=..�.s .�S•..-_G..li�c',�e-,.•L... ,:1'+..c-=-.�1., V'. �t 3. ' zi' T_.5..'6it Yi S�.fh'�.i �l �1 zi --i-��`�' p .r .y�g .�1 �t� •s .^.f -� ,fi..... - ..,.�,_... .6�_i...LE.: • 1:�PARKS t 1• .IMPACT. PUBLICDLD �.•• • • �ii SCHOOL I IMPACT FEE i5 SCHOOL IMPACT ••TOTAL POLICEIFIRE MISC FEES ©� ++ • • REQUIRED _M _ i :d�....l..0 3 h 'a. ✓t:�S. i.`r. � � • �,�, -t.?{� � _ If[[,, C �..s' ^';V. / -+y � ytLP f .5`ra ". �.;-�S:`i o.=..v.�x�..�s:.�� fi _ %'Dt_y '-rl' er<�lsaL 5 w,y'+_( 9r'.Y-`�'�?3',,��s2. ilt N ?"r il._ J•-�-' '-`13�`6+5.,-.4ti. {1 q .?,C�^�.f. .C"33!.l'. f.' ice! Fast Z �? -.S �h �h.i `. -. 1.. � 1 �5 � l S �✓.3a ... v.... Y �,,.,�. :.}Y +i F. � �1.7. .��" . �.i72 {"' 1. 7 3�. ( sl+. � � 1' � .� }. ice' if_ k .-} . . �#3+ i f':i"=^Y.:.«�_SS.•i:J i. i.':'s �-:. �- . s ..... .�_ .�e..ti-.,"f.. ,F, - �s.••r;«.,_�...,�,� _..- -_.._,.ice._ • • �• • • +: 111k: �.rffmnyn= V PERMIT NUMBER: V CERT. CAP. NO.: ALL O MUST BE -COMPLETE & FILLED IN TO BE ACCEPTED St.. Lucie County Bui(ding. and Zoning -� 2300 Virginia Avenue FL Pierce, FL 34982-5652 772 462 1553 Rptree 4SOZ DATE FILED: �° owl •n PLAN REVIEW FEE: RECEIPT NO.: CONCURRENCY FEE- RECEIPT NO.: l �I I I. LOCATION/SITE ADDRESS: am 2. S/D NAME I y) Z m 1 YQ mQ � e",[) SITE PLAN NAME: - I gyp, ,, 3. PROPERTY TAX ID #: 4yc2. 70 --4: --—L-EGALDESCRIP-T--ION attach-extra-sheets-if-necess ( ary): IZ�s.��•2--ar-l�cLf—�©rncd.�l C`�1l �trc�c� r Likii 5. PLAT 6. PAGE 7. BLOCK-� S. LOT BOOK NO. NO. NO. ��� �pr- � o5 ec_t �A n f EATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION l -Zol cx� IS Ur � 9. PARCEL SIZE:: ACRES/SQ FT. I�1[°f— LOT DIMENSIONS 10. DESCRIPTION F-CONSTRUCTION PROJECT OR WORK ACTIVITY : CrGF-C i �Q bYl IL SETBACKS (ACTUAL).- FRONT: BACK:. - RIGHT: LEFT:- t jy !44 i� (1q- SIDE ry LA—. .SIDE— I\Ay� - 12. TYPE OF CONSTRUCTION (Check al} appropriate boxes) j [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION. _ [ ] INTERIOR RENOVATION [ ] RESIDENTIAL /� ] COMMERCIAL 1 ° ✓ [ ] INDUSTRIAL ] OTHER (SPECIFY) [ DYl4 C4.. e 13. DESCRIPTION OF PROPOSED USE:S�CIQfyt�cil �a4 14 16. Sq. FtJCONSTRUCTION: VALUE OF CONSTRUCTION: $ CAD 15. Sq. Ft. Ist Floor: 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 consWction 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:—n-e— coo sac ADDRESS: )CCCX.7 S- De_Or2 , V{ tt''nn .CITY: �CO�il STAVE:.... _ ZIP' 3't"157 PHONE (DAYTIME): ( )2_) Z n - Kf-,3 0 email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE " FILL IN NAME AND ADDRESS BELOW. & "V7. FEE SIMPLE TITLEHOLDER: ADDRESS: - - CITY:, STATE: PHONE (DAYTIME): �) CONTRACTOR INFORMATION V �1007 a-7 ST. of FL REGJCERT #: ee' e__ DST. LUCIE COUNTY CERT #, BUSINESS NAME: QUALIFIERS NAME: 1 C hQ6 1 nlo��-ks ADDRESS: MSE L U yyd.o. " /W CITY: Shl Q V T STATE: ZIP T1'9� PHONE (DAYTIME): " 1�'ZD FAX NO�Z_ LD�2 lZ email: ARCHIVENGINEER: "� �cm C. o l ne_e_ c c� c�� �f Pei al.) ADDRESS: CITY:1C1 STATE, �-f"1_ ZIP PHONE (DAYTIME -m Z Z6, 4UDQ'�, BONDING. COMPANY: Qt ` ADDRESS: CITY- 'STATE:' � ZIP -... MORTGAGE LENDER:..:._ ADDRESS: CITY: x STATE: ZIP IMPORTANT NOTICE: When a permit is issued and if s-riot pieked up within 60 days after notification it will be voided and returned to you by mail. CERT FICATION. 1 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 prioF to the issuance of a permit and that all work will be perfornled to meet the standards of, all laws regulating construction in this jurisdiction. T understand that separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AND AM CONDITIONERS, ETC., not otherwise included with this building permit application. i The following building permit applications are exempt from undergoing a full concurrency review: room Additions, accessory structures (all types), swimming pools, fences, walls, sighs, screeh rooms, utility substations & accessory uses to another non- residential use. I NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. lF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOi,TR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT, NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMTT,IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBIEC,.:7' TO ATTACHMENT: HMENT: AS A CONDITION OF THIS PERMIT YOU PROMISE TN GOOD FAffH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. i OWNER'S AFFIDAVIT; I certify that all the fbregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. I AO49 ea OTi ONT CTOR SfGNATURE 'CON17RACTOR SIGNATURE STATE OF FLO % STATE OF FLORIDA COUNTV OF COUNTY OF�-- The foregoing inxtrument was acknowledged before The foregoing Instrument was acknowledged before me th day o - 0 we this64.0—day of, 20-0 by Alaty by A:&b-atS who is pees a�kno or who has produced who is Wally knpwn or who has produced as identification, A as identification. 'Sig tune of Notary Signatu ANNE M. CZERWINSKI Commission iV'..y, = ANNE M. CZER i ° gq#IMISSION # DD 385905 } f�411SSI0N # DD 385905 ° = EXPIRES: January 12.2009 esl) :,. . EXPIRES: January 12, 2009 E BondedTluu Notary Fabric underwriters `•` Bonded thm Notary Public Uncle "R ""` _ rwriters NINE: TWO (2) SIGNATURES ARE REQUIRED, EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR TMS BUILDING PERMIT AS AN OWNEWBUELDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION OWNER. BUILDER AFFIDAVIT WIXJ, RE REQUIRED FOR ALL OWNERfBUILDER APPLICANTS. i For specific instructions see appropriate permit checklist.