HomeMy WebLinkAbout1107-0046 APPLICATION FOR BUILDING PERMITSCANNED
OFFICE USE ONLY: Lude'Confltv
DATE FILED: %
PLAN REVIEW FEE: I.;j RECEIPT NO.:I� PERMIT NUMBER: r
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN T6BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
I Ft. Pierce, FL 34982-5652
772-462-1553 Cf/L
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJEC1 INFORMATION
1. LOCATION/SITE ADDRESS:®� 7
2. PROJECT NAME: ,Olnk 5-nne--
3. PROPERTY TAX ID #: I q44---1.—trr
4. LEGAL DESCRIPTION (attach extra sheets if
5. PLAT BOOK 6. PAGE NO.
9. PARCEL SIZE (ACRES/SQ FT.):
P,e-,-Ce--.PL 3
PLAN NAME: . C�r-- A G
-z. - - l Y-/ D . Old OL9 0
ec
844A,,Aie, lh. ,j I?e.A,L► club o.�
32.5T-zsy
7. BLOCK NO. 8. LOT NO.
DIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 114 S lam, l.l_
a
11. SETBACKS (ACTUAL). FRONT: QI [\ BACK: RIGHT SIDE: LEFT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[I,]�OTHER (SPECIFY) 3,9pf44,r-
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: j S-'C> !j , V--- 15. SF. FT I st FLOOR:
VALUE OF CONSTRUCTION: $ 1 4 S ® ® i)
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
UPDATED 6/25/09
OWNER INFORMATION
NAME: Nam(. PtN A 1 C. A 11~ W
ADDRESS:
CITY: r{ILT P 1115 RCS ST
PHONE (DAYTIME):nM
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY O)A
FILL IN NAME AND ADDRESS BELOW. {4dJ p
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME): C____)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: rC - 150 %0 t 3
BUSINESS NAME:
QUALIFIERS NAME:
STA
C
S
"rL ZIP: 3 °-A C( L
Email: 7Y0 1 P_��y►e Q I , (1-10 (Y)
IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
- "7')2- Z7% - -t 3 0 0
ZIP:
ST. LUCIE COUNTY CERT
ADDRESS: 1A 6y.k- Wilk Blo
CITY: Li . m �pj Cuf, STATE: ;FCC ZIP: /
PHONE (DAYTIME): c3Z() �� - �2�5� FAX NO. ;2l-7a9'011W Email: C (•
I�
ARCHIT/ENGINNcE�ER p,� ,�j}� ---�Y,1`1CR P�%'ess4;Ac r w�
ADDRESS:
CITY: !&O` rL* STATE: r(_ ZIP: y
PHONE (DAYTIME): " "� Q -7(14 — q �' Cr
BONDING COMPANY: i� d
ADDRESS:
CITY: STATE:
MORTGAGE LENDER:
ADDRESS:
16310
STATE:
MR
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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OR
STATE OF FLC4ftA
COUNTY OF
ff U10
The foregoing instrument was acknowledged before
me this (D day of 20 I
by ` C_ e Ne
A�w I/ I
who is personally known LI/or has produced
C RACTOR SIGNATURE
STATE OF FLORI
COUNTY OF Luc te,
The foregoing instrument wasr acknowledged before
me this 6 day of l , 20—LL
by �At-r�c•� liYillDU\�f`�
who is personally known ✓ or has produced
as identification. as identification.
i
S' of 44 .//' re o Nota
201ry
•O�dl s e�;'\SSION
ommission No. _ ) o . Q- Commission No.' 7$1(1�p�9�
Vo
J•
1115 •� Q
•'N:�aNPubV%r\P .' p���� * O00181ii5
NOTE: TWO (2) SIGNATURES ti���ACH SIGNATURE MUST BE NOTARIZED.-,*" :ON
THIS BUILDING PERMIT A�/ 11ij 1 �R/BUILDER, THE OWNER MUST PERSONALLY/ ��,
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. """' ��
tl11NH1�
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
I
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SECTION TOWNSHIP
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LOT OF RECORD
FEES I
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING: ! /
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- .REVIEWS
FRONT -
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REVIEW
3UPIItVLSORII .
REVIEW I
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
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DATE
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DATE
INITIALS
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