HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBP
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DATE FILED: a -1,9 �`�
PLAN REVIEW FEE: —L6 RECEIPT NO.: _ 3/b / PERMITNUMBER: O4 D,2 -0,3O/
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE az FILLED IN TO BE ACCEPTED
O\E CpG{ ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
20R1�P FORT PIERCE, FL 34982-5652 SCANNED
772-462-1553 BY
St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION �
1. LOCATION/SITE ADDRESS: 6-oy/ f 9, i', OA7Y 7 Y�C°fCL / 3S'98�
2. S/D NAME: %ndi'4n A'yei Z'-5C4t(f SITEPLANNAME: /
3. PROPERTY TAX ID#: J7�IGa God - O✓�J?4 aOn/O - 7 V)
4. LEGAL DESCRIPTION (attach extra sheets if necessary): Jn,d .0n—
/'/x4 519 Lai 36 li99p 3y/o�s��ar
5. PLAT. 6. PAGE 7. BLOCK 8. LOT
BOOK p»? NO. .26'�ti' NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. 0,000--Sr4 LOT DIMENSIONS SO >-�
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: /0/0/ '?es-1 /-O/r�- ✓ O
oe) 'o &e-k O�� PXl ��n�. �,dri �� i�/n Lf AL o�ei. h
l/dvtG K-2-
11. SETBACKS.(ACTUAL) FRONT. BACK: Li RIGHT p✓ LEFT I
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [tJrEXPANSION/ADDITION [ ] INTERIOR RENOVATION
[i,,K RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: �e4�o/en2 4/
14. Sq. FtJCONSTRUCTION: 5 7 15. Sq. Ft. 1st Floor: S
a0
16. VALUE OF CONSTRUCTION: $ .5,1 5-1 —
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.
0
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME:
ADDRESS:
CITY: /�' O,'efCe, STATE- ZIP J7
PHONE (DAYTIME): (Vi 9 7 9 — EII5� (41 029
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: _^44q
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG.ICERT #:
BUSINESS NAME: _
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
ST. LUCIE COUNTY CERT #:
ZIP
STATE: ZIP
FAX NO.
Aor ' 'q lial'r', STATE: ZIP A770
(W, 3346-Siam 337 - Lc68y
�ii
STATE: ZIP
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.
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
with all aad
foregoing information is accurate and that all work will
laws regulating construction and zoning.
The foregoing instrument v
jas acknowled9�ed,�
before met �l day , 20 by/h
'�V who is ersonaily known to me or who'
has produced � as identification.
Type o Print Name of Notary /
Notary Public Title
Commission Number
(seal)
CONTRACTOR
STATE OF FI
COUNTY OF
in compliance
The foregoing/ instrument was acknowledged
before met ' _ day of , 20_, by
who is personally known to me
or who s produced as identification.
of Notary
Type of Print Name of Notary
Notary Public Title
(seal)
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.