HomeMy WebLinkAbout0412-1777 application for building permitOF' �'FIC', U.SE: �� BY
DATE FILED: �+J► ���C,�IB��
v.
PLAN REVIEW FEE: RECE PT NO.:
LONCURRENCY FEE: RECEIPT NO.:
�FIL'E
1 PERMIT NUMBER:
i CERT. CAP. NO.:
ALL INFO MUST BE COMPLE
& FILLED IN TO BE ACCEPTED
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ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
772-462-1553
APPLICATION or BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJ
1. LOCATION/SITE ADDRESS: 5047 N. A1A N. Hu
2. S/D NAME: Atlantic View Beach Club
3. PROPERTY TAX ID #: 1414-610-0000-00017
4. LEGAL DESCRIPTION (attach extra sheets if necessa
INFORMATION
SITE PLAN NAME:
5. PLAT 6. PAGE L
7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. �LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: Demo interiors as per hygienist, repair framing.
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11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all ap ,'ropriate boxes)
[ j NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ X] INTERIOR RENOVATION
[ ] RESIDENTIAL [ j 1COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION:
16. VALUE OF CONSTRUCTION:
The Value of construction is used to determine4he
indicated value of construction if it is demonstrated t
or more, a RECORDED Notice of Commencement rr
15: Sq. Ft. 15S Floor
00.00
ount of permit fees toke assessed. St. Lucie County reserves the right to question and/or modify the
the submitted figures are not consistent with similar types of construction activities. If the value is $2500
be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME: Atlantic View Beach Club
s DDRESS: 5047 N A1A
`y CITY: North Hutchinson Is. STATE: FL
PFHONE (DAYTIME):
THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS D
ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME): _(_)
CONTRACTOR INFORMATION
N/
STATE Of FL REG./CERT #: CG - CA17617 ST.
BUSINESSNAME
QUALIFIERS NAME:
ADDRESS:
ZIP 34949
RENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND
ZIP
COUNTY CERT #: 18745
CITY: Vero Beach t
STATE: FL zip 32963
PHONE (DAYTIME): _(772) 234-5661 Fax: (7721 234-5662 .
ARCHIT/ENGINEER:
ADDRESS:
CITY: Fort Pierce STATE: FL zip ' 34947
PHONE (DAYTIME): _(772) 466-3773 I
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STA
ZIP
STATE: ZIP
IMPORTANT NOTICE: When a peI mit 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
of capacity, if applicable, for the permitted work. 1 certify tha
qq"f, a permit that all work will be performed to meet the stan
'i4hierstand that separate permits may be required for ELI
BOILERS, HEATERS, TANKS, AND AIR CONDITIONERS, ET
ft
Tqe following building permit applications are exempt fr
accessory structures (all types), swimming pools, fences, I;
to another nonresidential use.
NICE TO OWNER: FAILURE TO RECORD A NOTICE
FOR IMPROVEMENTS TO YO,'I
CONSULT WITH YOUR LENDER
COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR
PROMISE IN GOOD I
LAW NOTICE TO THE
vork and installations as indicated, and to obtain a certificate
no work or installation has commenced prior to the issuance
ards of all laws regulating construction in this jurisdiction. I
,TRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES,
not otherwise included with this building permit application.
undergoing a full concurrency review: room additions,
signs, screen rooms, utility substations & accessory uses
OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
R PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
i BUILDING PERMIT, IF IT IS NOT YOUR RIGHT. TITLE. AND
TO ATTACHMENT: AS A CONDITION OF THIS PERMIT YOU
DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN.
WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER'S AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in
compliance with all applicablellaws regulating construction and zoning.
'C
OWNERICONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF Indian River
The foregoing instrument was acknowledged
before me this 1 day oL Nov 20. 44 ., by Ted
S. McMillan who Is personally known to me or who
as produced as identification.
Signature of Notary
Marian C. Middleton
Type or Print Name of Notary
Notary Public Title
Commission Number
6cp�a1 0-1
(seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH
IF APPLYING FOR THIS BUILDING PERMIT P
TO SIGN THIS APPLICATION IN THE OFFICE
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF Indian River
The foregoing instrument was acknowledged
before me this 1 day of Nov. 20 04 _,by
Tery S McMillan who is personally known to me
or who has produced as identification.
Signature of Notary
Marian C. Middleton
Type or Print Name of Notary
Notary Public Title
DT3 1-111 3 S 1
Commission Number
ah'41a IV-7
GNATURE MUST BE NOTARIZED.
AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR
'TED ON THE FRONT OF THIS APPLICATION.