HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE USE ONLY:4-1�5-
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DATE FILED:I l Iff-Im` jqb4-6q4j
PLAN REVIEW FEE: RECEIPT 0.: PERMITNUMBER
CONCURRENCY FEE: RECEIPT;0.: CERT. CAP. NO.:
ALL INFO MUST BE
& FILLED IN TO BE ACCEPTED
PLANNIN & DEVELOPMENT SERVICES DEPARTMENT
BU DING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 5652
772-462-15531553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1. LOCATION/SITE ADDRESS: "/ 5
2. PROJECT NAME:
3. PROPERTY TAX ID #: 4 Sa -2— - S
4. LEGAL DESCRIPTION (attach extra sheets
5. PLAT BOOK 6. PAGE NC
9. PARCEL SIZE (ACRES/SQ FT.1�l
10. COMPLETE DESCRIPTION OF
1U61AJ Sare./—V-
11. SETBACKS (ACTUAL) FRONT
12. TYPE OF CONSTRUCTION (Check all
NEW CONSTRUCTION [ ]
[) RESIDENTIAL [ ]
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14.
16.
SQ. FT OF CONSTRUCTION: 2' I
VALUE OF CONSTRUCTION: $
The value of construction is used to determine the amount of per,
value of construction if it is demonstrated that the submitted figu
RECORDED Notice of Commencement must be submitted with
SLCCDV Form No.: 001-02
IJECT INFORMATION '3( 9 5 7
/l9 6 -r- r L L's
SITE PLAN NAME:
necessary): Nis 5 e- a -pa tD I N r,
A!LA s» Or27 a ,iT71 9 wJ e* L7 YMCA./ d-L-C WtZ-A/I
7. BLOCK NO. 8. LOT NO.
LOT DIMENSIONS:
A
'TION PROJECTOR WORK ACTIVITY:
BACK: RIGHT SIDE: G LEFT SIDE: 16 ,
>riate boxes)
ANSION/ADDITION [ ] INTERIOR RENOVATION
4MERCIAL [ ] INDUSTRIAL
15. SF. FT 1 st FLOOR / Z 7 6
6, &U-v
fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated
are not consistent with similar types of construction activities. i f the value is $2500 or more, a
application.
UPDATED 6/25/09
11
1
OWNER INFORMATION
NAME: _f< 1 I---V tfL�
ADDRESS: 26S'3 Iy,�. �Przvc
CITY: '37 STA
PHONE (DAYTIME): (77)2—' 3 3 -(-q 3 3 `{
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OW
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: ST
PHONE (DAYTIME): U
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: C /- C 5r'72. (o
BUSINESS NAME: b l+6FL E 4.# N- fz . Q i
QUALIFIERS NAME: i C 1.1• *'m 0 F -
ADDRESS: 12- `-'t o N !E: . 8 '-j S
CITY: -Y 5 C Aj STA
PHONE (DAYTIME): ( 7 9)7- �; 3 Y-L0 3 -/ FAX
ARCHITXNGINEER
ADDRESS:
CITY:
PHONE (DAYTIME): (_)
STA'
BONDING COMPANY:
ADDRESS:
CITY: ST.
MORTGAGE LENDER: "
ADDRESS:
CITY: ST.
IMPORTANT NOTICE: When a permit is is
it will be voided and returned to you by snail.
4
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1
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FE: i' L , ZIP: 7
Email: P- F m R S (S op cc M
ER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
ZIP:
ST. LUCIE COUNTY CERT #: l (10 ( -13
155 ?° i-fL i< P L-f+ C Z�
t= Z • ZIP: `3 Y g T -7
T72 ,33q-`13?.5Email: $LF YWk R6(kl"& ciL
ZIP:
ZIP:
ZIP:
and it is not picked up within 60 days after notification
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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 restrY PP rohibit 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.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this�day of 20�
by
-v'lre pepersonally known or has p o aced
as identification.
Signature of Notary
Commission
W
CONTRACTOR SIGNATURE
STATE OF FLA)
COUNTY OF
The foregoing instrument was acknowledged before
me thday of 20�
by
who is personally know or has pro uc
\
as identification.
Signature of Notary
DAI MILONE
1901ary Publjic - State of Florida
Mi Comm. Flxpires Mar 22, 2017
Commission # EE 877571
o��aoA rnr,,,6 National Notary Assn.
NOTE: TWO (2) SIGNA
THIS BUILDING PERMIT AS AN Of
THIS APPLICATION IN THE OFFICE
OWNER BUILDER AFFIDAVIT WILL
For specific instructions see approp
DAWN MILONE
Notary Public . State of Florida
My comm. Expires Mar 22, 2017
AVU5rGMftURE MUS3SMN96
:ifGE19: " hl� MCP
t/BUILDER, THE OWNER
TED ON THEFRONT OF TA I N.
REQUIRED FOR ALL OWNEWBUILDER APPLICANTS.
. t
le permit checklist.