HomeMy WebLinkAboutBUILDING PERMIT - CERT OF CAPACITY - ZONING COMPLIANCE•
OFFICE USE ONLY: 1.Z% a 0DATE FILED: to 7 C
PLAN REVIEW FEE: • 0 • RECEIPT NO � PERMIT NUMBER: 071) ���
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
I.
2.
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4.
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ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
'$ < St. Lucie County Building and Zoning
2300 Virginia Avenue // r�1
< RI Ft. Pierce, FL 34982-5652 C. :
772.462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE QPAd1►1[
PROJECT INFORMATION BY
St Lucie C
LOCATION/SITE ADDRESS:
S/D NAME:
PROPERTY TAX ID #:
LEGAL DESCRIPTION (attach extra sheets if necessary): S 36 `fC C / a, 0j N tc yy of N W
of SE 1/y - Less M;dvJau Rot_ aS in Oft 2ao-19`1rl
PLAT 6. PAGE 7. BLOCK
BOOK NO. NO.
411
II
PARCEL SIZE: ACRES/SQ FT. 't. 109 AC LOT DIMENSIONS _
10. DESCRIPTION OF CONSTRUCTIOrN PROJECT OR WORK ACTIVITY:
Comekek- :L1 tC v IC,r \AhriT k� i GYM Y� Y
rw o�CsM'J4+�5�5 .
12.
13.
SETBACKS (ACTUAL) FRONT: BACK: Nip RIGHT-
'L.
' SIDE "
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCT
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
8. LOT
NO.
LEFT: NAl
SIDE
[ ] EXPANSION/ADDITION INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
DESCRIPTION OF PROPOSED USE: am Mev Ct O-A vt-fl co-- 6U-41 u t:9
14. Sq. Ft./CONSTRUCTION: L+ ate' 15. Sq. Ft. I st Floor:
16. VALUE OF CONSTRUCTION: S �J O OCO C)C
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 S2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
/
NAME: h, l -4 _ j rc U i-)rCt z&q
V
ADDRESS: a945 W, tAIC VIJO--' M
CITY: R P1 e V QPL. STATE:
FL- ZIP 3 c19 I
PHONE (DAYTIME): (1 A) Lf 64 - 91 b0
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: STATE:
ZIP
PHONE (DAYTIME): O
/
v
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: C G C R 13 7 q rI
Q
ST. LUCIE COUNTY CERT #: V 0
BUSINESSNAME: --T)eo-WcUj CynS%L'Q--ior)
71F.'SnC.
QUALIFIERS NAME: 'ir o ff W m ne -br4 L I
ADDRESS: a94 S W. M t d w LJ P
CITY: Ft • PI errs.__ STATE:
FL- ZIP 34g8 I
PHONE (DAYTIME): '1(ga) 4j4- 81�60 FAXNO.
`1`1a-44,4 o3h0 email:
ARCHIT/ENGINEER:
ADDRESS:
CITY: STATE:
ZIP
PHONE (DAYTIME): (_)
BONDING COMPANY: N I R
ADDRESS:
CITY: STATE:
ZIP
MORTGAGE LENDER: R
ADDRESS:
CITY: STATE:
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.
0
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, 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 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: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
v 1 �
OWNEP/Cb#nRACTOR SIGNATURE CONTRA TOR SIGNATURE
STATE OF FLORIDA
COUNTY OF S+• LIJ-C QJ
The foregoing instrument was acknowledged
before me this 0-day of IN 0-�t , 20t' l by
r -Drftv-& . who i ersonal y
own to me or who has produced
as identification.
Signatut of Notary
0 I-u S+o-t S . G,- to n
Type or Print Name of Notary
Commission No. DD 5b730 (Seal)
STATE OF FLORIDA
COUNTY OF S} L LA c1 C✓
The foregoing instrument was acknowledged
before me this IL day of Y' CK, 20Pr? by
d who ersonally�
own to meXir who has produced
as identification.
Signatu4 of Notary
Cx us+4A & C-meen
Type or Print Name of Notary
Commission No.DD 50361 (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.
•tit::. CRYSTALS. GREEN .iMij .c- CRYSTAL S. GREEN
MY COMMISSION R DD 667361 r MY COMMISSION k DD 567361
W. A; EXPIRES: September 4, 2007 �;= EXPIRES: September 4, 2pp7
"'%F'•'`�" Bonded TNU Naery Pubk Undxxmers '•�,;qr;h• Boded thru Notary puCllc WdeNynien
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