HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITi
OFFICE USE ONL
DATE FILED: 1
PLAN REVIEW FE& cc, I ,Q4�� �� CEIPT NO.: Imzll PERMIT NUMBER 1 � O
CONCURRENCY FEE: RECEII'T NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: q8 Ne-H Ie5 [AI V d ) r ,SC(N Geach pC_.
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX IP..#:
4. LEGAL DESCRIPTION (attach extra sheets ifnecessary):lVe•Nlts Tsi .-A T'n /� 01\C10 a $eC 1' 11 prClr-C�
am(I psrp4dfa sKare Lle\ cow")r\ ekhr, Is (c�R �Ssy��0�51
5. PLAT BOOK 6. PAGE INO. 7. BLOCK NO. 8. LOT NO.
`� tLg pp ^^
9. PARCEL SIZE (ACRES/SQ FT.): L L�OTDIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PICT OR WORK ACTIVITY: '®
-- &-L -1 ci new hcl w,,.e _ S`
11
SETBACKS (ACTUAL) FRONT: BACK: ) 1 RIGHT SIDE: 1611 1
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[,,f NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: fC
Z' '
14. SQ. FT OF CONSTRUCTION: {'
16. VALUE OF CONSTRUCTION: $
Z d)
M
LEFT SIDE: ' V4
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
15. SF. FT 1 st 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 construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION
NAME: V-l rr, - - C (/I Cry 0 r%y-; (%
ADDRESS: _Qk /Lje,- is 61ud .
CITY: j �,s-t.n h STATE: ZIP:
PHONE (DAYTIME): 5( d$) Z Z I - ?a$cj 4 Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
i
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTDvIE):
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: Qrjg41 Z ST. LUCIE COUNTY CERT #:
BUSINESS NAME: KA-r P 14y C o Il�, itjdiQ n
QUALIFIERS NAME:
ADDRESS: I UgL1 'S. (!)C(fCE+f, C)ir. .
CITY: 3&rSe� Ge-CL C -\ STATE: r L ZIP: q s
PHONE (DAYTIlVIE): 172 22Q- c c/c3/q FAX NO. "2"12-22Ct-Q%/6 Email: ►n C� jyLP�
ARCHIT/ENGINEER: —V4 � D�` )' yve-S I G" e
ADDRESS: y _j nl
CITY: `� �C%�`4 �? j STATE:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
ZIP:
STATE: ZIP:
STATE: ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
n
it will be voided and returned to you by sail.
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 al 1.
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 Homeownerjs 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, fencesi walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
I
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 WITHYOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
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
'PURE
STATE OF FLORIDA \
COUNTY OF C� e
The foregoinpg, instrument was acknowledged b4ore
me this day of MGM 20 1 J f !
by LJ4 K, m -To��
who is personally kn� or has produced
as ioenntcation.
Signature of Notary
DA /ib N. KNEPPER
Commission No. 1P*! ` : k CorgSWtgn #kDD 995518
'a Expires September 25, 2014
%'.F„p��cy°:1`• Bonded Tlw Troy Fain Inwmnce 800,485-7019
r
CONTRA TOR SIGNATURE
STATE OF FLORIDA 1'
COUNTY OF Srt
The foregoing instrument was acknowledged before
me thisc39 day of.201q ,
by M0,0< b�1 G1�S
who is personally kno� or has produced
as identification.
Signature of Notary
Commission N "'Py� _, DAVO N. KNF�??
.: ission #�'b155518
Expires September 25, 2014
Bonded ThmTroy Fainlnwiance8OMS-7019
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, 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.