HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSECTION: I �5 S
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FIRM MAP #.'
OCCP TYPE:
LOT OF REC (aftr 1/90)
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BUILDING 8 ZONING DEPARTMENT, —-
® 2300 VIRGINIA AVENUE
20RIOQ FORT PIERCE; FL 34982-5652 { Q [ Ivr 0 ' v'
- 561-462-'1553 _
APPLICATION for BUILDING G' '
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS: 7320 a o2e c
S/D NAME: i SITE PLAN NAME:
PROPERTY TAX ID #: !?
LEGAL DESCRIPTION (attach extra sheets if necessary): e x� S' i L O'Ge- '
"p' I- m`:T ,6�/, 0-r- •c)o2 jr4-r-joeo 7o3 -7-&7 7
5. ,PLAT 6. _PAGE 7. BLOCK 8. LOT
BOOK Zoo NO. /(0 NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. 'D r�C LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: TEArA"V7'_1 /P/evW �'rtiT
11SETBACKS,(ACTUAL')-4--FRONT , .� ' BACK: IGHT LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) MM
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft,/CONSTRUCTION: 777-G,f 15. Sq. Ft. 1st Floor: $Ds3 !mod
Z�yo� _. SCANNED
16. VALUE OF CONSTRUCTION: $ i BY ����nr1fifi��
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie CouniyerCeOrvLSYfie 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
OWNER INFORMATION:
NAME: _
ADDRESS: -
K �T
/ _6.0 ).e r
CITY: i��. �/'R/ STATE: '�L. ZIP 3��..
PHONE (DAYTIME): I* /W�" O C(O 26
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): I I
CONTRACTOR INFORMATION
ST. of FL REGJCERT #: CBCA S-7 pl - ' ST. LUCIE COUNTY-C,EER-T�{#: - 5 523
BUSINESS -NAME:_ 044:TT ��'Sr�'f^CT7�� `�"—_' //vG 0
QUALIFIERS NAME:
ADDRESS:
CITY: r
PHONE (DAYTIME):
ARCHIT/ENGINEER:
ADDRESS:-,. '
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
S/ • '_` STATE: ZIP
(%lRr Z ZO ' 00l0, FAX NO. 7-20 - O ZZ�7
fa
STATE. _ ZIP �35o7g
( �&1) W'00
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.
l 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.
I certify that all the foregoing inform
with all applicable laws regulating
STATE OF FLORIDA
COUNTY OF rrlarh�
The foregoing instrument was acknowledged
before me this �a'�ay of , 20 M, by _
P,a, t D rih personally known to r who
has produced as I entification.
Signature of Notary
Y"'1�YG.� f�2r5Ctvl�
Type or Print Name of Notary
be done in compliance
STATE OF FLORIDA
COUNTY OF M arlfiil
The foregoing instrument was acknowledged
before me this OIo�day of = . 20 cTt- , by
Gl +� + SJe Lek, w ersona y cn o me
or who has produced as Identification.
Diu•-� 13-2-�!
Signature of Notary
fr 1t rr'l Cb.e�t7Yl
Type.of Print Name of Notary
Notary Public Title Notary Public Title
Dig 9-6- Commission Number 4p0)396L'ibommiss(on Number
tiN^i: MIMI BEWON ENrON MIMI B
(seal) r.?`! Cr7MMISSiDN # DD 139024 (seal) ,' MY COMMISSION # DD 139024
EXPIRES. August 5, 20D6 EXPIRES: August 5, 2005
awa Th. wwy Rb6c Untlemnlers ..
° Ffm`� Ba Ttuu NotWPuMCUMBrmRem
NOTE: TWO (2) SIGNATURES ARE REQUIRED. CH SIGNATURE MUST BE N
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.