HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY
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DATE SENT TO ADDRESSING:
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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OFFICE,USE ONLY: ,r� - "
PLAN REVFILEIEW FEE: i RECEIPT NO.: / G� ��S PERMIT NUMBER j�/ Q
CONCURRENCY FEE: ti _ O l7 RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE LET'E & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
EIS T
BUILDING & GODE REGULATIONS IDrv'BION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772462-1553
0
APPLICATION for BUILDING PERMIT
CERTIFICATE ®f CAPACITY/ZONING COMPLIANCE
PROJECT
1,_ - LOCATION/SrMADDRESS: 2� 10 fil4a414
2. PROJECT NAME: SITE
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO.
Q
PARCEL SIZE (ACRES/SQ FT.):
OF
7. BLOCKNO.
LOT DIMENSIONS:
PROJECTOR
8. LOT NO.
11. SETBACKS (ACTUAL) FRONT: 10 BACK: 1:5 RIGHT SIDE:- / S LEFT SIDE: IS
12.
13.
14.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
[ ] INTERIORRENOVATION
[ ] INDUSTRIAL
I Wn v R
SQ. FT OF CONSTRUCTION: 1� 15. SF. FT 1st FLOO
16. VALUE OF CONSTRUCTION: $ C-11 7
The value of construction is used to deteunine the amount of permit fees to be assessed. St Lucie County reserves the right to question and/or modify the indicated
res a react consistent with similar types of wnstmetion activities. if the valuc'ls $2500 or more,a
value of wnsWctionifitis demonslmted that the submitted figu
RECORDED NotiecofCammcocemmi mustbc submitted with this aPPitwhoa. - - -
SLCCDV Form No.: 001-02
I
t UPDATED 6l25/09
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CITY: Q! Yl f STATE: /' I ZIP: T WOW
PHONE (DAYTIME): Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELO .
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): C__)
C®NypACT®R ONFOR RA7o®H, I-Io na y
Jl. r?
ST. of FL REG.CERT #: U S YCA ST. IE CO CERT #:
BUSINESS NAME: 0
QUALIFIERS NAME: 1 ✓SOU
ADDRESS: I5b
CITY: (0�10��tt t STATE:
PHONE (DAYTIME): 5ot"f �ci�J7 FAX NO. Email:
ARCHITIENGINF,ER: --/U
ADDRESS:
CITY:
PHONE (DAYTIME): C_ )
BONDING COMPANY: IV! '
ADDRESS:
CITY. STATE:
MORTGAGE LENDER A/ .Lit
ADDRESS: "L
CITY:
STATE:, "'T
IV
t'tY
)IUPORTANT NOTICE: When a permit is issued;"� �
it will be voided and returned to you by mail.
_ LO h
fro
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CERTIFICATION: 'AP
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.
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 TT 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.
W
OWNER OR CONTRACTOR SIGNATURE
STATE OF ff
O
COUNTY OF _cg/Z
The foregoing instrument was acknowledged before
me this _0_day of r20�1
by L ki A s na_CN
fvho is personally known ,-' or has produced
JANCY MIMS ARMSTR�sRONa'G
Y eeMMISStON # EEo562
EXPIRES January 30, 2015
/I zn'�
CONTRACTOR SIGNATURE
STATE OF A
COUNTY O ` t f2
The foregoing instrument as acknowledged before
me this _��(��day of
$r1Far t�
who is personally known _L or has produced
asidentift
Signature of Loft
c'R"'F✓s. n NCYMIMSARMSTRONG( al)
MY C�E059652
''.'�u.a�,,•` EXPIRES January 30, 2015
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR.TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNERBUH.DER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERIBUIPER APPLICANTS.
F ,
tlletiols see appriate permit eheckust.or specific ispr®
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