HomeMy WebLinkAboutBUILDING PERMIT APPLIACTIONOFFICE USE ONLY:
DATE FILED: 1 \' 13
CONCURRENCYFEE RECEIPT NO.: CERTMICANNP. O.: (3]j b\05
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PL-INNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce. FL 34982-5652
n2462-1553 6CANNED
BY
APPLICATION for -BUILDING PERMIT St. Lucie County
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: $(ego As 5un Vet.(I¢t bR, �24i�:`tc/rN FL 31179/
2. PROJECT NAME: FFISiyr k5flS. ienc2 SITE PLAN NAME:
3. PROPERTY TAX ID #: 13 ]a- $o (— p87O ^ 0y0 — 0
4. LEGAL DESCRIPTION (attach extra sheets ifnecessary): for 13�?0 r,6f�,KO ShofeS 10c,. - b o 1L
5. PLAT B6OK '.- L 6. PAGE NO. taA_ N 7. BLOCK NO.Qeho�i%,o 8. LOT NO.
Owo
9. PARCEL SIZE (ACRES/SQ FT.): MtO LOT DIMENSIONS: iS SC 1 [ S
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
Y C
c
11. SETBACKS (A AL) FRONT: BACK: RIGHT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
LEFT SIDE:
[ ]. NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ RESIDENTIAL LL COMMERCIAL [ ] INDUSTRIAL
j ] OTHER(SPECIFY) / o p/
13. DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION:. 3 Z 7S ST ti 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: S I / 02
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 consnvetion activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6r25/09
OWNER INFORMATION
NAME: O ,P (S /
ADDRESS S62 S-1Z
CITY: CH STATE: ZIP:
PHONE (DAYTIME): (___) Email:
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):
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: Ky/I� Z�C� ST. LUCIE COUNTY CERT
BUSINESS NAME: AQ E W 2rO
QUALIFIERS NAME: Ae)A6'e—r—
CITY: tT /Pi'l P STATE: !G ZIP: k 3--15 LZ
PHONE (DAYTIME): (7&. Z%S— 2 7df) FAX NO. L� n�—/D lo3Emai1: �PWX/i SQ L/ cD.CM
ARCHITBNGINEER: -- l� /' %%li1)f S i
ADDRESS: G S— J ""
CITY: to /OL STATE: ZIP: 3a96
PHONE (DAYTIME): 07A.«
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
KAW
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, FENCES, 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 Homeowner's 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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT 1S NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY 1S SUBJECT TO ATTACHMENT.
r �VA
OWNERkoRlqNTRACTORSIGNATURE
STATE OF FLORID
COUNTY OF !:� `g
The foregoing instrument was acknowledged before
meth,� is/da�y of _A(1_ �, _20
by - h
who is per ovally kno _Lelb� has produced
COINTRACTIORSIPNA R
STATE OF Fi O MA
COUNwOF
The -foregoing instrument was acknowledged before
methis1_7_dayof LCr .20
who is personally known tf"'or has produced
as identification. _ as identification.
ftirafore of SHEHHILFT reofNola
MY COMMISSION / DD 970255 ¢� SHERRI L FENUM
Commission No. " EXPIRES: March14,2014 Commission No. + II-Y1r};OMhW10NiDD97&%
N�q�wnoe°� Boded TNd Budget Notary Sense o �'Bxr]RES: March 14, 2014
�q?ands' BadMThni Budjetmq Soicea
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUILDER, 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 OWNERIBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY #: 1311- o No 5
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DATE SENT TO ADDRESSING:
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