HomeMy WebLinkAboutBUILDING PERMIT APPLICATION}iGlYY15
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ST. LUCIE COUNTY PUBLIC WORKS
< BUILDING 8 ZONING 3DEPARTMENT.., 2300 VIRGINIA AVENUE .... SCANNED
j�c 20RI�Q FORT PIERCE, FL 34982-5652 B�
772-462-1553
1J St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFOR IT,ION/l
1. LOCATION/SITE ADDRESS: ! �J I � ho r+ 111 Pyl
2. S/D NAME: �aKes /j SITE PLAN NNAAMEL:� PG� Y / /Ian_
3. PROPERTY TAX ID#: 3334_ 50t- 6Nq- Ow// -
4. LEGAL DESCRIPTION (attach extra sheets if necessary): N0� l0/ 81ac4 o-F l ,fires o-4- y f fl �
QCco din 4o -Fhe lc�f `hereof (eariri f'a �oK `�3 fades vz,A-F
+k7plrob&C ecar s Sf.t�JcrPcoun y, Dior/'
5. PLA PAGE �) 7. BLOC FC 8. LOT / BOOK NO. 32 ;Q4 F NO. NO. to
9. PARCEL SIZE: ACRES/SO FT. / U LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
iOX 11 S(�
11. SETBACKS (ACTUAL) FRONT: _ BACK: �/' RIGHT / i LEFT �y
ICJ SIDE l0 SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
i
[�] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
MANGROVE 14. Sq. FtJCONSTRUCTION: ; 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION:
The value of construction is used to determine the amount of permit fees to be assessed. SL 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
OWNER INFORMATION: r
NAME: r Tohn
ADDRESS: / oS % c..J/ / 1?0X qW/ � 61 �•//
CITY:.. .. -.: .. .. O o I /�/!fj ,^.'. /> STATE:._. .ZIP
PHONE (DAYTIME): L7571 �I _ r�l �� �(.:f/ v� �3Y�
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER:
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
ADDRESS: TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
CITY: STATE: ZIP
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
•s YOUR NOTICE OF COMMENCEMENT.
PHONE (DAYTIME): f 1
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
CONTRACTOR INFORMATION PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN
/1 I� LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
ST. of FL REGJCERT #: lei CO5 rI joo ST. LUCIE COUNTY CERT #:
BUSINESS NAME: 5 COI'1GYC8b, To OWNER'S AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in compliance
QUALIFIERS NAME: c+krjY -44 �^'I L-n with all applicable laws regulating construction and zoning.
ADDRESS: "C% lU�_,S(gea or 7•4VQ C
CITY: .`-f .Q �'p/ t✓1' 2. �/_ .. STATE: ///- �- /,, / zip J `t / O Z
PHONE (DAYTIME): _L7�Z1 V�O-7-75 Z- FAX NO. i 7- Ill/ZT 0 NER/CO CTORSIGNAT R CONTRACTOR SIGNATURE
STATE OF FLO ID STATE OF FLO �IDA/ ,,
COUNTY OF 9JUCr e COUNTY OF J o e.
ARCHIT/ENGINEER: I"�Q�j RPanlb Yr�-1-
The foregoing instrument was acknowledged The foregoing i trument was acknowledged
ADDRESS: _ b fore me this � day of Fes, 2QO-6, by Spjn b fore me this /0 day of �20CI , by
CITY: STATE: Zip Q rY s , who is personally known to me or who'- 1414-hu✓ Al />Pn who is -emanal, Iv k,� to me
has produced D.L. - as identification_ or who has prod d as identification.
PHONE (DAYTIME): f I .
Ignat lr o Notary Sig lure o
BONDING COMPANY: �J
ADDRESS: [Donnie Dare pjOrinl� rL .
Type or Print Name of Notary Type of Print Name of Notary
CITY: STATE: Zip ..
Notary Public Title Notary Public Title
MORTGAGE LENDER.
ADDRESS:
CITY:
STATE:
LP
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.
Commission Nur0pi................ Commission Number
BONNIE BARE1................................:....o
(Seal)
E P (seal)BONNIE BARE
®CommN 4
23923
E*im.4/2812od] Dw# DDM2'39"
Bonded thm (].OY32<2�I* EV1=4)2],7M
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7")'S'5.....................:...............: F1cm!a tj� ,'4 •f, FF
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST �ED: ^ ^•
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNE4fBUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.