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HomeMy WebLinkAbout1308-0399- APPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYOFFIC USE ONLY: [�� DATE PILED: — E C- O . k (c y. PLAN ' VIEW FEE: ©0 • RECEIPT NO.: i__ P�T NUMBER CONCVRRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED r = PLANNING & DEVELOPMENT SERVICES DEPARTMENT JNTY PROJECT BUILDING INFORMATION 1IL LOCATION/SITE Ai)nRF.CS- ) f l *-I ry � % . t r / //�dI �/ 2. 3. 4. 5. 9. 10 11 BUILDING &CODE REGULATIONS DIVISION 2300 Virginia Avenue � � Ft. Pierce, FL 34982-5652 772�62-1553 a APPLICATION for BUILDING PERMIT ���jj CERTIFICATE of CAPACITY/ZONING ITY/ZONING COMPLZ��CE� PROJECT NAME: PROPERTY TAX ID #: SITE PLAN NAME: LEGAL DESCRIPTION (attach extra sheets ifnecessary):_i V-&j rLjej r L? /✓ 0 PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. PARCEL SIZE (ACRES/SQ FT.): 4 3 LOT DIMENSIONS: AV / % f1�K I M COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: /� e C 1 —/ a0 SETBACKS (ACTUAL) FRONT: BACK: 12. 11 TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION RESIDENTIAL [ ] OTHER (SPECIFY) RIGHT SIDE: [ ] EXPANSION/ADDITION [ ] COMMERCIAL 13. 41 DESCRIPTION OF PROPOSED USE: LEFT SIDE: [ INTERIOR RENOVATION [ ] INDUSTRIAL SQ. FT OF CONSTRUCTION: / 2 S / 15. SF. FT 1 st FLOOR: 16. 6 VALUE OF CONSTRUCTION: $ 9/ (%a C7 The val a of wnstruction 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 o 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 RECO ED Notice of Commencement must be submitted with this application Form No.: 001-02 UPDATED 6/25/09 OWIN ER INFORMATION CGf� NAME '� Z. Z, V ep, l_ C//L&--r Z,/- . QS" Y ADD ,' SS: 2020 LL� CITY: ' ' Llr,,e STATE: ZIP:Z— PHO (DAYTIME): d5 y t �z-�- Email: C Y CA L-3 IF FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL 1, 1 NAME AND ADDRESS BELOW. FEE SI MPLE TITLEHOLDER ADDRESS: CITY: STATE: ZIP: PHO (DAYTIME): (__ CONTRACTOR INFORMATION 1 ST. of L REG.CERT #: CAC 6 A ST. LUCIE COUNTY CERT #: BUS SS NAME /��/1.� OU IERS NAME: L &MY- F 1--F'_N rS.. - _ - CITY: v (� STATI1 T4— ZIP: 3-1ygI PHONE (DAYTIME): ( q Ik —!gM&AX NO. Email: o- ARC T/ENGINEER: CITY PHO (DAYTIME): BO ING COMPANY: Ann Fec- LENDER: STATE: STATE: ZIP: ZIP: CI STATE: ZIP: IMP RTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification it wi 1 be voided and returned to you by mail. I r CERTIFICATION: This apr ication is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity, if applic ble, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all work wi I be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits may be equired for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,, AND AJ CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application. St. Luci County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure which i in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such structur ;, Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. The foil building permit applications are exempt from undergoing a full concurrency review. room additions, accessory structurill (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non- resident use. 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. 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. OWNF OR CONTRACTOR SIGNATURE 9 CONTRACTOR SIGNATURE zrn m STAT OF FLORIDA O � Z c STATE OF FLORE CO Y OF m �v COUNTY OF The fo egoing instrument was acknowledged before The foregoing instrument was acknowledged before a me thi day of 20, me this day of ��� , 20/�' , by1; byf7,P� L �� who is lersonally known or has produced %��rt"'' who is personally known or has produced •r �� C_ _ as identification. M. c d%' C as identification. v 2WE Signat re of o ary _ Z Signature of Not �rnmrn Commssion No. (Seal) o 8 Commission No. (Seal) a 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 Opecific instructions see appropriate permit checklist.