HomeMy WebLinkAboutBUILDING PERMIT APPLICATION. 5
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CONCURRENCY FEE; RECEIPT NO.: . CERT. CAP..NO.:
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`1 BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue - Vi"V10 Ft. Pierce, FL 34982 5652
772-462-1553
AP ICATION for BUILDING PERMIT 4 RC-iw&5
CERTIFICATE:of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS: /Ld L!i_ /G% PAtNN�sr—�,�- —
PROJECT NAME: �[y/r�:lG�i SITEPLANNAME: SP�!i��[2y �+tu
PROPERTY TAX ID #: 3 4 d q --'4 3 l - o oo) - 000 - � St. LUC1e C ^^ tv
LEGAL DESCRIPTION (attach extra sheets if necessary): LET f - 64=4 LL
PLAT BOOK 6. PAGE NO. 7. BLOCK NO. _:_ 8. LOT NO.
PARCEL SIZE.(ACRES/SQFr.): !�( !�" `S' LOTDIMENSIONS: /fJa %,y-o
COMPLETE
DESCRIPTION
� OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
SETBACKS (ACTUAL) F)k
TYPE, OF W ONSTRUCITON (Check
CONSTRUCTION .[
[ ],,RESIDENTIAL [
OTHER(SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
r=v BACK: T-
tpropriate boxes)
RIGHT SIDE: 1 4 ` Z LEFT SIDE: ZK-- .F
EXPANSION/ADDITION:
COMMERCIAL
[ '] 'INTERIOR RENOVATION
[ ]. INDUSTRIAL
14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION:' $. 30 o
The
value of construction is used to determine the amount of permit fees to be assessed. St. Lucia 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
St.CCDV Form No.: 001-02
t� ill �Yt 1� cc, � L
p a - 12 UPDATED 6125109 t
OWNER INFORMATION
NAME: — ( P' ' � T-'C
ADDRESS: /2-0(0 . I
C=:
PHONE (DAYTIME): 6M V/Z-
IFTHE FEE SIMPLE TITLEHOLDER
FILL IN NAME AM ADDRESS BEL
ME SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAY IEvill):
r & Z": wee )l
Email:
,IS DEFERENT FROM THE OWNER LISTED ABOVE, PLEASE
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CONTRACTOR INFORMATION
ST. of FL REG.CERT #- (p 16 7 ST. LUCIE COUNTY CERT #-
BUSINESS NAME.. a u. D Se—) Po c> L5.
QUALIFIERSNAME: H7,,-)-
ADDRESS: — ?'0
CITY
STATE: ZIP:.
PHONE (DAYTIME): Email;
r.
ARCHITIENGINEER.
ADDRESS:
C=: STATE: 21P:
PHONE (DAYTIME): (--)
BONDING COMPANY:
ADDRESS:
CITY: STATE:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE::
mig
VA-I-J*
IMPORTANT NOTICE: When a permit is issued and it is not picked up witlik 60 days after notification
it will be voided and returned to y 1 o)m by mail..
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CERTIFICATION:
This application is hereby made to obtain ajpermit:to. do the work and installations as indicated, and :to obtain a certificate of capacity,'
if applicable, for the permitted work. I certify that;uo work or installation has commenced prior to the is 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, PLUNIBIIVG,-SIGNS; WELLS,, POOLS, FURNACES; BOILERS, IIEATER9, TANKS,
AND AIR CONDMONERS, ETC., not otherwise included with this building permit application.
The following building permit applications:are exempt from undergoing a full concunency 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 ANOTICE OF COMIvIHNCEMEI1T MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOURPROPERTY. IF YOU INTEND TO
OBTAIN FINANCING; CONSULT WITH YOUR L$NDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERNRT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTBRI 'ST THAT IS! SUBJECP TO ATTACHMENT; AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD.FATTH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LJEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT. "
OWNER'S AFFIDAVIT: I certify] that all the foregoing information is acc 'and that work will be done in compliaycc
with all ;applicable laws regulating/constructio an zo '
v
OWNhRj9A tOJ!3&CTd4S1GNATURE CONFRACTOR-SIGNATURE
STATE OF FLORIDA
COUNTY COUNTY OF �) � Zee,
The foregoing instrument was acknowledged before
me this day of v20_�,
1�
by �✓G//��
who is personally known V or who has produced
The fore-going
Instrument.was acknowledged before
me this�ilay oL—!Z w 20.E
by
who is personally known or who has produced
as identification. as identification.
Signature of Notary n
^, °�" &•� SHEHRILFEHLMM SignatmreoYNoctary� aP`**`-% SHERRILFE
CommissionNol_ r0��� * MYCCMMISSION"0970%ommissionNo.1�_ 7e * MyCCMM1SSI0N1
EIPIRES: March 14, 2014 : EXPIRES: March
a^��FOFFO"Op awdedilw 6a'get NMary Saviga '�arnoo-�° aaitledllwarw„r �r.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH' SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT ASIAN O*NER/BUILDER, THE OWNER Mt!JST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF T13I8 APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist,
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