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INITIALS
DATE FILED:
PLAN REVIEW FEE: 00 dZi RECEB'T NO.: �J� lS/ PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
ECGy. _ J�-elf C -
St. Lucie County Building and Zoning�js•
-- 2300 Virginia Avenue - - -
'�ORIOp'� Ft Pierce, FL 34982-5652
772-462-1553 0'�"-"• f UY 0 . -
APPLICATION for BUILDING PERMIT'
CERTIFICATE of CAPACITYIZONING COMPLIANCE
PROJECT INFORMATION SCANNED
BY
1. LOCATION/SITE ADDRESS: 1535 NpoW SuTTONQGLSFI GRG.E StA1�r�, ieCnun
2. PROJECT NAME: PGNICNAKkgQt'dcnITEPLANNAME: PeMictvAk
3. PROPERTY TAX ID #: 4 02 B 5 a -t p
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5' / - 9 5; -
V(ARBOtAZ RID6E-PLAT 13->3uT-(G1\)BuSH VILLMC- r,Auir 2l
5. PLAT BOOK 6. PAmpl/ AGE NO. 7. BLOCK NO. �q G 1 8.. LOT NO..
9. PARCEL SIZE (ACRES/SQ FT.): ! dLOT DIMENSIONS: � ae"'i l
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
'MZAG,E AOD1710N To GARAGE /Z9'5" S40-1.3—
11C&SETBACKS(ACTUAL) FRONT:` q-13 BACK: N/A RIGHTSIDE: 15-(l LEFT SIDE: IN/A
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:: OSTO(zA(n 1) NQ HVA&
14. SQ. FT OF CONSTRUCTION: `�� ` 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $ ZO. OOO
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
e�
A
OWNER INFOR ATION
NAME: TONN A17¢(Au� l�EutcN�K d. Fk)M
ADDRESS: m7 7> >W rJV• I I u1y VUVn �m�
CITY; PALM C l rY 2 / I' n STATE: EL_
PHONE (DAYTIME): (%%7l- /l0 l` o't b Email:
ZIP: 3gf 140
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
STATE:
,
ZIP:
ST. of FL REG.CERT #: CG C 115O K I S -7 ST. LUCIE COUNTY CERT #: a�Cl 7
BUSINESSNAME: LiBt:2TY (,%7NF BUILDERS ��✓
QUALIFIERS NAME:, JCFF2eS' IM wA LS H
ADDRESS: 5-85 SW ett-TVAORE ST
CITY: BOP-T- ST. L(Ae (E STATE: pFL-
PHONE (DAYTIME): D7) 1 (22 FAX NO. f1 /�"0032i
ARCHIT/ENGINEER:
/�
Email: J 2
ADDRESS: (0`7/ JIA) I C
CITY: POU ST, Lucie STATE: FL ZIP:
PHONE (DAYTIME): 7( ) (D,3 (- 5)og
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
olr
MIA
'6�)M
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.
".°, SqAr—
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 required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, 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 Homeowners 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: 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: certify that all the foregoing information is accurate and that all work will be done in compliance
A -certify
all applicable laws regulating construction and zoning. All
OWNER bR MNTRACTOR SIGNATURE
STATE OF FLORID
COUNTY OF
The foregoing instrument was acknowledged before
me this ]�! day of 204P9
by
who is personally known �'or has produced
?°aWr nn LNDA FLAKE
Commissign Oct ONnDDX0r1 )
EXPIRES:n-dehBUd9 13L 2011
"+�.�n�:°` BaMedTlw ButlgelNotaryservies
/ 1;1,J4Q1KAl:1VK J2li1VA I�YJK6
STATE OF FLORID
COUNTY OF
The foregoing instrument w acknowledged before
me this day of/ 2 gq
who is personally known has produced
as ide�tifleation.
r e of Notary
3' �OEommissiJNDA�AIff (Seal)
. , MyCOMMISS IN#DD715 0
u,�2•an�'�' EXPIRES: Eft N3' 201s -
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.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.