HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONDATEFILED:
F
ILED
PLAN REVIEW FEE: /,50 RECEIPT NO.: 0o2S
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.:
i
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue S/►/Ip1'tlr' s
Ft. Pierce, FL 34982-5652 10099''11�N
772-462-1553 BY
M Lude ftnty
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITEADDRESS: 141.4 el�ar/S�IV�G/I Fe.3�1957
2. PROJECTNAME: SiOR-M PAM4C d SITE PLAN NAME: FeW PiLrT.eaS 2vsi
3. PROPERTY TAX ID #: 9 -4a — S3 I — f 07Va — azwl
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 1A , 37 `// SW / 80 FT IJF'IV Ly 51-5,1
F7 AS Al A CI
5. PLAT BOOK 6. PAGE NO.
9. PARCEL SIZE (ACRES/SQ FT.):
7. BLOCKNO. S. LOT NO.
LOT DIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: 96-PA/%p- &m-(6rAL -
cS�o2M 179AlAGC� /a EX/,S9in/G 57fLuc>u/2Gr
11. SETBACKS (ACTUAL) FRONT: BACK:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
13.
14.
16.
[ J NEW CONSTRUCTION [ ] XPANSIONa
[ J RESIDENTIAL ['COMMERCIAL
[ ] OTHER (SPECIFY) tr 5141
RIGHT SIDE: LEFT SIDE:
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION:
VALUE OF CONSTRUCTION: $ '7 5 /lilU • da
[ INTERIOR RENOVATION
[ ] INDUSTRIAL
15. SF. FT 1st FLOOR
The value of construction is used to determine the amount of permit fees to be assessed St. Lurie 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
I
UPDATED 6/25/09
OWNER INFORMATION
NAME: A j e&—;2 9 Lsu s'TAC65` ( U-r7- t/ ,L L.L' )
ADDRESS: /QW j- l>c6A/U ID e.
CITY: "&1215e211 /gC// STATE: 1-�G • ZIP: 3zl�
PHONE (DAYTIME): U Za /v -79 94k V/ 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:
PHONE (DAYTIME): C__)
CONTRACTOR INFORMATION.
ST. of FL REG.CERT #: L G C 0
BUSINESS NAME: f
QUALIFIERS NAME:
STATE:
ZIP:
24
ST. LUCIE COUNTY CERT #:
CITY: U/L� L�C//fi�J ra7 STATE: FL ZIP: 3 Ll9 7ZI,
PHONE (DAYTIME): /49 yam/
ARCHIT/ENGINEEyR RA b LrA) le 32 q � c3N
ADDRESS: zi -% s-0� COC o it 7 4 Il CITY: e57-6C42T STATE: F41 ZIP: .34/-7G
g4,
PHONE (DAYTIME):
BONDING COMPANY: A 1A
ADDRESS:
CITY: STATE:
MORTGAGE LENDER W//t
r
ADDRESS:
CITY: STATE:
ZIP:
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.
A
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 pemtit 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 IS 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 IS SUBJECT TO ATTACHMENT.
%MWER'011 CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF ;rWAq
The foregoing instrument was acknowledged before
me this /r day of 4_,+ UT20 / 3 .
by R67- �PW_rl`cE
who is personally known V"or has produced
identification.
........""".. ' MICNAELBERGIN
�^ Notary Public, State e1 Florde
Commission No. �—i ) Commissiom!EE 11741
My oomm. e:OT&S August 20, 201
,sG U
SIGNATURE
STATE OF FLORIDA S?
COUNTY OF
L„1G1l'r.
The foregoing instrument was acknowledged before
methis 2S dayof J'AJuAr-J 20�
by
who is personally known _ or has produced
FLgt—' (%Mill y lif42 asidenflfication.
I %
Si ature of Notary
(SW A. SANTANA
Notary Public - State of Florida
My Comm. Expires Mar 29. 2013
Commission # DO 875366
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE O "°" "" '
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUS PERSONALLY APPEAR.TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE' FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
I
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SPECIFY
MECHANIC_ ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
_
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING _
FEES