HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ON_L_.
DATE FILED: R
AN REVIEW FEE: RECEIPT NO.: PERMIT'NUMBE:.�' b.
.PLAN � .
CONCURRENCY FEE: RECEIPT 'NO.: CERT. CAP. NO.: ,
ALL. INFO MUST BE COMPLETE &FILLED• IN TO BE ACCEPTED
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PLANNING & DEVELOPMENT SERVICES -DEPARTMENT
BUILDING &CODE REGULATION DIVISION
2300 VirgiIma_Aymue .
Ft. Pierce, FL M982-5652 �O
7724624553
APPLICATION for BUILDING PERMITS
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS:-
2.' PROJECT NAME:. Sk, SITE PLAN NAME:
3. PROPERTY TAX ID #: k -
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. . , PLAT BOOK l� y 6. PAGE NO. Vt J� 7. BLOCK NO. 8. LOT NO. C�
9: PARCEL -SIZE (ACRES/SQ FT.): `S LOT DIMENSIONS:.
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
11. . SETBACKS (ACTUAL) FRONT: �� °� BACK: RIGHT SIDE:. LEFT SIDE: V �c
12. TYPE, OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [; ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ]. OTHER (SPECIFY)
13. DESCRIPTION'OF PROPOSED USE: \ " 0— `� O � e
`.S�':
14. SQ. FT OF CONSTRUCTION: 7 �fS 15. SF.'FT 1st FLOOR:
16. VALUE OCONSTRUCTION: $ . ROO
F.
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
0
OWNER INFORMATION
NAME: wlicsAO
ADDRESS:
CITY:'STATE: Z7ti ZIP: y`O�VO
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 SIMPLETITLEHOLDER:.. ' I -
ADDRESS: I '
CITY: .. STATE:. ' ZIP:
PHONE (DAYTIME):.
CONTRACTOR INFORMATION
ST. of FL'REG.CERT #: ST: LUCIE COUNTY CERT #:
BUSINESS NAME: 4Z17-�-C'.xv
QUALIFIERS NAME:'`w
ADDREss:��]L4A \\3 k�3 :
CITY: ��P� C'�:1�f1�� STATE: ZIP:yC\�
W
PHONE (DAYTIME): ���- aDl� FAXNO`'�Va-DDO)7,' 9Email:�S\6e
ARCHIT/ENGINEER:
ADDRESS:
CITY: �o STATE: ZIP:'
PHONE (DAYTIME):
BONDING -COMPANY: .
ADDRESS:
CITY: STATE: ZIP:
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.
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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.
zs+r -�
OWN O CONTRA OR SIGNATURE CITRACT~O SIGNAT
STATE OF FLO A STATE OF FLORIDA
COUNTY OF COUNTY OF
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this day of OC:V 20 �3 ,
who is personally known ✓or has produced
as identification.
me this _day of Ck_ , 20 �3 ,
by __Kt*V \S'Si viit' V
who is personally known ✓ or has produced
as identification.
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STELLA7ELLq M HSignature o o y,,, STELLA �Mtary Public - _ �tar P UNTERP�g, ubficState of Florida
:°`�Notary Public - SComm. E.pi s; 1S y Comm. ExpiresJan 23,Commission 0 • . 'J • .: m. E� i Commissio 9 2diS
Pr i11 r1tr5 uS 31278
Commission ded Through N I IVhtsfyAssn. nded Through Natrona) Notary Assn.Bnnded Through NatiqV
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.