HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONFCC,
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DATE -FILED: - /_ `7 - p S;'
PLAN REVIEW FEE: S �� RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE U FILLED IN TO BE ACCEPTED
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BUILDING & ZONING DEPARTMENT , � /�" /
2300 VIRGINIA AVENUE G '
FORT PIERCE, FL 34982-5652 S
7Aff
72-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
ev
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1. LOCATION/SITE ADDRESS:.310 0 S / • L- d 6l � ��✓ ITT, SCE a Lucie County
2. S/D NAME: 9,41 P�Irp TA ulv,, l SITE PLAN NAME:/ 5r L 6 S igl1 j �G��✓S�c
3. PROPERTY TAX ID #: _ /"1,2 �R' ?O;�- D - aab�°I
4. LEGAL DESCRIPTION (attach extra sheets if necessary): z v
6h
5. PLAT. 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
10. DESCRIPTIO
N OF
CONSTRUCTION-PROJECTOR WORKACTIVITY:
� 6 c�
11. SETBA
CKS(ACTUAL) FRONT: BACK: RIGHT
SIDE
J 7
i
LEFT
SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
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NEW CONSTRUCTION EXPANSION/ADDITION J INTERIOR RENOVATION
[;!] RESIDENTIAL fjJ COMMERCIAL [ ] INDUSTRIAL
[`] OTHER (SPECIFY)
1 13. DESCRIPTION OF PROPOSED USE: cz� ( /
14. Sq. Ft./CONSTRUCTION:g'�jj_ 5. q. Ft. 1st Floor:
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16. VALUE OF CONSTRUCTION: $ a f /6 OO
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.
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SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME: /t/0 (7�✓ S1 D15 &N t J-�/A-/'1 ';5' L2L' � jo cr,,
ADDRESS: �3 �® `-'' S • /"C
CITY: - � l�l CE STATE: 12' ZIP --
PHONE (DAYTIME):
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: S TE: ZIP
PHONE (DAYTIME): ( 1
CONTRACTOR INFORMATION /
ST. of FL REG./CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:yp 4- / c/
PHONE (DAYTIME): L! T Z)
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
1
0
e 7 7 A -S,Z.g: 9?33
7) 6
ST. LUCIE COUNTY CERT #: ;� 0 V�� C
6
STATE: /�L P
FAX NO. 1 0 0
STATE:(/ ZIPG��'
ZIIP ,: ! `..
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 maybe required for ELECTRICAL, PLUMBING,_ SIGNS, WELLS,_POOLS,-FURNACES, BOILERS, HEATERS, _
TANKS, AND AIR CONDITIONERS, 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, utility substations & accessory uses to another non-
residential 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.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE, AND
I INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS PERMIT YOU
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN
LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER'S AFFIDAVIT:
OWN
STATE OF FI
COUNTY OF
The foregoing
before a this
� who
Of
(seal)
I certify that all the foregoing information is accurate and that
with all applicable laws regulating construction and zoning./
TURE
5a
Was, acknowledged
20 9, by YAP. d
r known to me or who
. N A. SV,/ARn.EL
Public . Stale "a2
Notary
�T'jCOMM'6'10f 1 p270338
= Commission # . ,tnry Assn.
STATE OFF 0 I A
COUNTY OF
The fo oing instrument
for ' his �X�1ay of .
ho is e
o has p du d.
nature of Notary
(seal)
will be done in compliance
acknowledged
-, 20 2�, by
v known to me
I ✓\
LYNN A. SWARTZEL
Print Na °` PNptary Public -State of Florida
' • Commission
ry Publi Commission # DD270338
Bonded By National Notary -Assn.
Commission Number
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.