HomeMy WebLinkAbout0502-1081-APPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY[;TION:
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DATE FILED:
PLAN REVIEW FEE: 45 61,CL,1 RECEIPT NO.: 10c41 PERNUT NUMBER:U,3 —IU e
CONCURRENCY FEE: X'eQ RECEIPT NO.: CERT. CAP. NO.:
-BE CO PLUE-st FILLED IN TO BE ACCEPTED
ALL INFO MUST M
o
C
�f. UcIE, COUNTY PUBLIC WORKS
ED1WEN I N`G=&Z01WN`ARTG795R
2300 VIRGINIA AVENUE
Ij FOTPIERCe,;f0
OR R34.9 5652 .
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
Ila,
1. LOCATION/SITE ADDRESS: qcoPSL- 3t4gg(
F-� 9(,aiL�bjk
ReDe,7
L L
2. S/D NAME: & SITE PLAN NAME: 3
3. PROPERTY T'AX'-I'D
1l- V,
4. LEGAL DESCRIPTION (attach extra sheets If necessary): 5 Lx
5. _-PLAT-...- 'T; ',-'.LOT
6. PAGE 7.
NO.
BOOK 14?) 'No. NO.. 1.3
9. -PARCEL-SIZE: ACIF F-T-1. .16.1c �S i674LOT.DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT QR,.W.ORK-ACTIVITY._
11. SETBACKS ACTUAL FRONT:✓ BACK: RIGHT,.� LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
M NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION
DCJ RESIDENTIAL 1'...,COMMERCIAL. INDUSTRIAL
OTHIEkjSOECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: 15. .4q, Ft. 1st FlQpr7,..
16. VALUE OF CONSTRUCTION:
The value of construction Is used to determine the amount of permit fees to be assessed.. St Lude County reserves the right,to,question.and/or;modify the
Indicated value.of jMli*0994 1!•,kdqFms a _thp!,ffi ubmitt6dr",figures br mot, Istent Y'Vift.-similgr typHeew 0-061"S"fructi bn�act[v1066; If the val deig;$2500
of more,.3 RECORDED Notice of Commencement must be,submitted vA#i.jhIS application. ,
F
XDV Form No.: 001-02
NER.INFORMATION: jr
IE:L
RESS: 1 P6RUK RACE- S�,
STATE: 1^ L. -ZIP - �;.
'72-
NE (DAYTIME): (7 3� y - S466 ,
IE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
)W.
SIMPLE TITLEHOLDER: tN. / A '
RESS:
STATE:
NE (DAYTIME): ( )
ZIP
(TRACTOR INFORMATION - V
f FL REGJCERT b SL I Z) ST. LUCIE COUNTY CERT #: 1'7.68/
NESS NAME: KoL.T E
N&-7,LLRz
['tdMES
LZ1G
-IFIERS'NAME:�$�2T
J Vy4lL_
LESS:
4RK'
�F4CE
�a:R'r 5T
C1J�C1.
STATE:
ZIP
IE (DAYTIME): (m)
6 3f
FAx N0.
IITIENGINEER:
:ESS: Z 1-) le, "' >` L rM I c::)o
STATE: "iIp
IE (DAYTIME):
iING COMPANY: /At
ESS:
STATE: ZIP
ri
GAGE LENDER: A
ESS:
3,l 9 $ 6
33`L2lp
STATE: ZIP,
ORTANT NOTICE: When: a permit 'is issued and it is� not picked up within 6 da s
,-r notification it will be voile and returned to you ti ` 'Irma 1.
Y
CERTIFICATION:'
This application is hereby made to obtain a permit to.do the,work and installations as indicated, and to obtain a certificate of
a....
capacity, if applicable, for,the..permitted-work _I_certifyahatnowork 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
s,.parate permits may be required for ELECTRICAL, PLUMBING, _SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,
TANKS, AND AIR.C-ONDIT(ONERS, ETC., not otherwise included with this -building permit application.
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; utilty_substations &_accessory uses to another non-
rE:sidential use.
NOTICE TO OWNER:
FAILURE TO RECORD.A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT.
nv I IL:t 1 U APPLICANT:,. AS THE APPLICANT -FOR THIS BUILDING PERMIT, IF IT -IS NOT YOUR RIGHT, TITLE, AND
INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS PERMIT YOU
PROMISE IN GOOD FAITH TO DELIVEkA COPY OF THE ATTACHED CONSTRUCTION LIEN
LAW NOTICE TO THE -PERSON WHOSE P.ROPERTY1S SUBJECT TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify -that all -the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating constru d zoning.
• 5
OWNER/C RACT 'R SIGNATURE CONTRACTI�7
AT.UR
STATE OF FLORIDA STATE OF FLORIDA
CQUNTIC_OF 5T _ZI-..:._ OOUNTY OF
'The- foregoing instrument was acknowledg�e�d� ��� The foregoing instrument w s acknowledged
{ by� before me th's da of, i20d , by .
befor me this ay of 2
o Is ersona n o me who ✓ who is personally nown to me
h s prod ed as identification. or ;.h s produced as 1 ent icarion.'
Si tune of Notary S.
re of Notary
i ini�� n oyµ� Y�J
Type or Print Name of.,Notary Type of Print Name of-Notary
y Notary Public Title Notary Public Title
Commissi e...N MOO
t_Y pp0232ass Commissio umber
Exp►' 9I2 � NNE MOORE
'(seal) thru t�)`32 Convn# DD0232M
Bonded . )nc. (seal) . Expires 8/2312007 •
Florida Nola Bonded thru (800)4324254
i; Florida Notary Assn-, Inc.
NOTE:- TWO (2) SIGNATURES ARE REQUIRED.. EACH SIGNATURE MUST BENOTARIZED.'
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.