HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT-/L
OFFICE USE ONLY:
DATE FILED: .J �
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: ::;&Q0 RECEIPT NO.:
PERMIT NUMBER 1J 09' 0MO
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue �Jj %��i'� r�' 0
SrMf+/A1 NNLU Ft. Pierce, FL 34982-5652 Vl v
772-462-1553
APPLICATION for BUILDING
Iiienc,Ulf�l
PERMIT 61�(Y�7 j.
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: ZO g W-W M &\t d . �f nSQ1 ?J02' Ch, f_L S y q fD__1
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #: 4 J ®2. - 6 O 1- 0- ?l - O Gn- q
4. LEGAL DESCRIPTION (attach extra sheets if necessary):'NQ � Ies 1 S[4 rvri -lt\C , a e.4 r'6 d - Sccbp" 1 i
w(ceI ?A and OSO-rnfa sr'nie 'I , Celmmpn Citmeml!' k(af 3-!5S-l-1�'iI
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
'22 5
9. PARCEL SIZE (A S/SQ FT.): Z r LOT DIMENSIONS: /Kz
�O(/ES'C)/
10. COLe TION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 1
. I L, . 1 - ,
V
11. SETBACKS (ACTUAL) FRONT: BACK: J RIGHT SIDE: p LEFT SIDE:
12.
C
13.
14.
16.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ NEW CONSTRUCTION [ ] EXPANSION/ADDITION
] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION:
VALUE OF CONSTRUCTION: $ iI , 000 • 0
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
� X4 0- -'9-V `;7 c %3 5
15. SF. FT 1st FLOOR: / G
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
'�.j
UPDATED 6125109
OWNER INFORMATION
NAME: ZQrsi e14 (=sl0C1
ADDRESS: C-1r(a e- Alker-
CITY: q r cAum STATE: C pma 6 a ZIP:
PHONE (DAYTIME): (_ )
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:
PHONE (DAYTIME): (___)
CONTRACTOR INFORMATION
STATE:
ZIP:
ST. of FL REG.CERT #: Q.59 Ll 12 ST. LUCIE COUNTY CERT #:
BUSINESS NAME: "ic I- a, Cy rNstyucki`ar,�
QUALIFIERS NAME: �-A CZ C Y- T'--A a t6 S
ADDRESS: 6 01i b I �j . () C I°Cuf\ 1J f .
CITY:.),cm &C1Ch STATE: C-L
PHONE (DAYTIME): (-L-7?j 22ct- gL43cl FAXNO.-1?2- 7?c(-g y q( Email:
ZIP: 3 y g151
rnacy.(5)me1-r L cam
ARCHIVENGINEER: -7-O Nr-' C re S3L-j e P C 17-10a z
ADDRESS: 'L41-I `)q SE C-�, bi'r� A ire .
CITY: SiUc).r STATE: L ZIP:
PHONE (DAYTHVIE): CU 2) ` - i 6 - G i
BONDING COMPANY:
ADDRESS:
CITY: STATE:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE:
ZIP:
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.
WNER OR CONTRACTOR. SIGNATURE
STATE OF
COUNTY OF URIDAgt Lqe I\
The foregoing instrument was acknowledged before
me this day of 20 1S
by \\_ ,,
who is personally known --A or has produced
as identification.
ULU
CONTRACTOR SIGNATURE
STATE OF FLORIDA � Uae�� COUNTY OF
The foregoing instrument was acknowledged beforeme this � day of 206,
byC-i�
who is personally knowny or has produced
as identification.
Signature of Notary Signature of Notary
"'• DAVID NNEPPER
Commission No. •''i'��td''•. Commis #l�D gg5518 Commission N r'P DAVID N. KNf�
Expires September Co
#I±
mmission D 55181
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•,'�pd'�+;. ndedThmTmYFain
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUII.DER, 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.