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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONCERTIFICATION: OWNER INFORMATION NAME: ,per SXd ADDRESS: V Z_� qZq 1— .. 9/ - /Y7W r 1 G' X,?It� / CITY: /�'Olo"P//Gt7�? STATE: 3 . .�h ZIP i©tom 3 PHONE (DAYTIME): 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: PHONE (DAYTIME): CONTRACTOR INFORMATION ST. of FL REGJCERT #: BUSINESS NAME: Z QUALIFIERS NAME: STATE: fAI7 ST. LUCIE COUNTY CERT #: �© V/z ne ADDRESS: '///`�i13 �'� ��/G( / GilkG/e CITY: /C T /� e CG/ G� STATE: 11!f Z_ ZIP PHONE (DAYTIME): (Z%z)_ 5((a $3/0 FAXNO.`?'7Z yip 1311 email: ARCHIT/ENGINEglZ:. ADDRESS: 7 �z / rnaL. PHONE (DAYTIME): BONDING COD ADDRESS: CITY: ADDRESS: CITY: 7 Elm _ STATE: ZIP 77-6 ® STATE: ZIP ZIP 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 concarrency 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. OWNER/CONTRACTOR IGN TUBE STATE OF FLORIDA COUNTY OF 1Sr�� r /et dj l The foregoing instrument was acknowledged before me this Zk day}' of 7-4— , 20 b by / ` 7enuc eylz 1 , who is personally tome or who has produced 11 id e� Or✓, k r-- as identification. CONTRACTOR IGNATURE STATE OF FLORIDA COUNTY OF 5- LUCIE The foregoing instrument was acknowledged 'before me this7U day of.hU'le , 20PQ by crrTD 63� LJ I Up who is personally known IQ in or who has produced as identification. Si ature of Notary �a N7.ir� CA �IJfY l� NOTARY PUBLIC -STATE OF FLORIDA Type or Print Name of Notary ] y (� JoAnna M. ZencIIA Commission # DD541270 Commission No.)805 f/o240(Seal) Expires: AFR 26, 2010 Bonded Thru Atlantic Bonding Co., Inc. NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURI THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OW Signature otlNotary it will be voided and returned to you by mail. For specific instructions see appropriate permit checklist. OF REC (after gem LOT SPLIT APPROVED _�y`.yx$fl+�i �'�4 @+�i� '"F.'ui � h\S•Sh`aa-!4ki tT '°§.F"rn`J4 it)'k Ks� fi.yyefS'�aJ: -f iv k'^'! Abe .1`Ml yp�,....�=5 s.W'" � {�.�`a�'x�✓,5r.�n��' *£ :v ' h2'shv'' �. � y z� P..vti x f �,y,.�`��� E�T�.��' i eii�Fi y„� ��v �=�k..`�'2 IMPACTFEE •'-= �'•c'4't�'FyE Y owl ®® l T• y .. I c5 IMPA FEE IOTA ®� ADDITIONAL TOTAL • , ' FEES p�z�-m— 005 .- it � DATE FILED: —7 11-1 PLAN REVIEW FLEE. InQ RECEIPT NO.: A- 1 G 1 PERMIT NUMBER: O (90-7 ' O31 `t' CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: 2. 3_ 4. 5. 9. 10. ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St. Lucie County Building and Zoning 2300 Virginia Avenue c�OR1F1 Ft. Pierce, FL 34982-5652 772-462-1553 ` t� tC)G APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION SCANNED BY LOCATTSt. Lucie County ON/SITE ADDRESS: GI S/D NA PLAN NAME: PROPERTY TAX ID #: / �� 7rS O l - (�%D Z Z_ LEGAL DESCRIPTION (attach extra sheets if necessary): s�b 0-4 'dose � OEMe Jye 72-ac7' jvor 5 0 S� �ue�^� �3y �'// �� <A,& /of.✓1 PLAT T 6. PAGE 7. BLOCK 8. LOT BOOK NO. NO. NO. PARCEL SIZE: ACRES/SQ FT T DIMENSIONS DESCRIPTION OF PROJECT OR WORK ACTIVITY: SETBACKS (ACTUAL) FRONT: BACK, RIGHT: I LEFT: SIDES SIDE 3% TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ J� EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL "v COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 'e & do 5 14. Sq. FtJCONSTRUCTION- t 15. Sq. Ft. Ist Floor: 16. VALUE OF CONSTRUCTION: S < 6, q 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. SLCCDV Form No.: 001-02