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HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE USE ONL �,%., f , DATE FILED: � J 3I wel?, Mint, PLAN REVIEW FEE: RECEIPT NO.:�z PERMIT NUMBER: CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: i - ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION I 2300 Virginia Avenue , Ft. Pierce, FL 34982-5652 772-462-1553 // I Qqriar& - fb-4j;('9 CJQC�� -nbe - S, Dw--� APPLI CATION, for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJJECT�A_INFORMATION 1. LOCATION/SITE ADDRESS: 1504D I /o 7t .0 VI-4 310 2. 3. 4. 5. 9. 2-a o b -`-�'< � PARCEL SIZE (ACRES/SQ FT.): I © 4, 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: SETBACKS (ACTUAL) FRONT: �� BACK: _� RIGHT TYPE OF CONSTRUCTION (Check all appropriate [ ] NEW CONSTRUCTION RESIDENTIAL [ ] OTHER (SPECIFY) [ ] EXPANSION/ADDITION [ ] COMMERCIAL DESCRIPTION OF PROPOSED USE: -}� LEFT SIDE: [ ] INTERIOR RENOVATION [ ] INDUSTRIAL SQ. FT OF CONSTRUCTION: 'eo-6• 53 15. SF. FT 1st FLOOR: VALUE OF CONSTRUCTION: $ 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 CITY: -j CX---- q S�TE: —i' • ZIP: PHONE (D TIME):0�- l Email: 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: STATE: ZIP: PHONE (DAYTMIE): L_) CONTRACTOR INFORMATION ST. of FL REG.CERT #: 1 OAS I� STf BUSINESS NAME:YJ- QUALIFIERS NAME: O CV-r\ ADDRESS:LfA��(- CITY: nn TATE. PHONE (DAYTIME): cy; (POG �FAX NO. ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): L_) BONDING COMPANY: ADDRESS: CITY: A - STATE: STATE: COUNTY CERT #: ' ZIP: Email: ZIP: F' MORTGAGE LENDER: JIV-\ ADDRESS: CITY: 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. r 4 S 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 graniing 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. I OWNER OR CO47(6-p TOR SIGNATURE STATE OF FLOCOUNTY OF — The foregoing instrument a acknowledged before me this 6 day of " T by I p� C who is personally kno or has produced as identif tion. gna re of o o, NANCY MIME v10` °` L MISSION # EE059652 CONTRACTOR SIGNATURE STATE OF FLORIDA 00—� COUNTY OF The foregoing instrument was acknowledged before me this )_qday of ► r �Jl� 2014 , by O CLS r l l_ (n &-d who is personally known or has produced as ide ation. 71 igna ure of N t y Z. °: MY COM 2015 Commission q. �; ES Jan(q Commission NO. ItQ •PRYP�A�• NANCY MI S)VISTRONG i�,OFF �u•• $eNICe.COm `2• o (407)398.0153 Floridallotary ' A� MY COMMISSION # EE059652 EXPIRES January 30, 2015 (407) 398-0153 Fla_rideNotaryService.com NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUS APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUULDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. For specific instructions see appropriate,permit checklist.