HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFIGEGJ$EQNL•Y:
BP #: 0?a/012/23
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TOWNSHIP:
RANGE:
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ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
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FIRM MAP #:
1ST FLR ELV:
MAX HGT:
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LOT OF RE (b
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LOT OF REC (aftr 1l90)
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TOTAL ALL
PERMITS
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DATE FILED: /U'oR"1�0 /
PLAN REVIEW FEE: SU RECEIPT NO.:QLL2Vd [pJ P � PERMIT NUMBER: AA/601 2 3
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MAST BE COMPLETE 8t FILLED IN TO BE. ACCEPTED
its coy SCANNED- °-'l0 �o Cu7ce
.BY ST.'LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
St. Lucie �ouMy FORT
PIERCE, IA FL U98 -5
ORIOQ• FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMA
1. LOCATION/SITE ADDRESS: ��� .J (S�C��� /J e/14 .fir(/
��.�/2. S/D NAME: SITE PLAN NAME:
.a
3. PROPERTY TAX ID #: V61Z—z?'—QO cll--0cJoO
i
r 4. LEGAL
DESCRIPTION
i DESC+RIPTION (attach extra sheets if necessary): X-�� #,zt
nr ,n % (2-57 SO �yLL^ P 4t ENlt//n ��accl6'� �a� S�nE�ae
5. PLAT 6. PAGE 7. BLOCK 8. LOT
i BOOK NO. NO. NO.
a
9. PARCEL SIZE: ACRES/SQ FT.
LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: _,C�» crate /t2s Iw ra
C) A 4 1C-0-t1If-5
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
SIDE SIDE:
12.
13.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION
[ ] RESIDENTIAL
OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
14. Sq. FUCONSTRUCTION: rT o o 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: $ 3 2 M 00
The value of construction is used to determine the amount of permit fees to be assessed. St Lucie County reserves the fight 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.
.qry
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
_ 0P_/iSP/1 F ea'CX STATE: �C ZIP
3V957
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW. i
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME): ,tom_
CONTRACTOR INFORMATION
STATE:
ST. of FL REGJCERT #: CGC o (e it) 33 .ST. LUCIE COUNTY CERT #:
BUSINESS NAME: •_�U' 4ur-e - Co rC- 1
QUALIFIERS NAME:
ZIP
ADDRESS: 1`tirc f�E Z�ean \J Cu�IP �oZ
CITY: r-rA STATE: '17L• ZIP 3449.E
PHONE (DAYTIME): 1`7 7a1 ;Q --- iy�-
ADDRESS: ".1e6 6 r!-6/'i5
A
CITY: Y • ���/»p 1?eP _pC7
PHONE (DAYTIME): J:Oil
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
FAX NO. 7 7a 2�22-6 Fly 9
STATE: �C • ZIP Jq3 1/6
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.
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: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction
and zoning.
OW ER/G N-tRA&T-biZ SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLO ID
COUNTY OF T.
The foregoing instrument as acknowledged
for me this oda of 20113, by
o i ersonally known to me r who
has rodutNotary
as I en I (cation.
//Signat
Type or Print Name of Notary
Notary Public Title
Comm=berD. H.AF"'ON
SiON 0 cc 912269
(Seal)Febmary 20, 2004
Budget Notary Swry s
STATE OF FLORIDA
COUNTY OF /LJ�i✓
The foregoing instrument was acknowledged
before me this dvD day of , 200f-, by
/fb(xFYF who is person known to me
or no has produced Identification. L�^'v /U
i n re of No
1069AXnA47T_;1'
Type of Print Name of Notary
Notary Public Title
on IiADOLATO
:r M ION d DD 247960
:a EXPIRES: September8,2007
(seal) rti Bandedmw NoaYP Wden Mers
Sve
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.