HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONDATE FILED:
PLAN REVIEW FEE: .50- RECEIPT NO-: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACC�E�PT'pE_D//�I/
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St. Lucie County Building and Zoning ��//����11pppp
2300 Virginia Avenue 6 -
<OR1O Ft. Pierce, FL 34982-5652 SLAW (��
O C / - 772-462-1553 V N. �YN
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APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1�flr1(gG A-1,�PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: \/,/ NO ;?_\ V r? 1bdKm RoAr�
2. S/D NAME: Gl SITE PLAN NAME: .
3. PROPERTY TAX ID4:—1�225OZ00�2000� /
4- LEGAL DESCRIPTION (attach extra sheets if necessary): /b/�/oct% otK'&7 8, A %4A4-
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5. PLAT 6. PAGE 7. BLOCK FF W C'1 tS '- 8 70T
BOOK NO. 3 Z NO. NO. _
9. PARCEL SIZE: ACRES/SQ FT. ?,i 5 qI q. �OT DIMENSIONS
10.
DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: NT4
SrrO&\
\ 6000 L-4m
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SETBACKS (ACTUAL) FRONT: BACK: oI / RIGHT:
W (°t SIDE
LEFT:
SIDE w
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
] W CONSTRUCTION [ ] EXPANSION/ADDITION
[ ]
INTERIOR RENOVATION
SIDENTIAL [ ] COMMERCIAL
�[ 1.4aY�\\W
f 1
INDUSTRIAL
���- OTHER (SPECIFY)�,A�i C-\1T/L
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13.
DESCRIPTION OF PROPOSED 'USE:
14.
I
Sq. 1 ��
FtJCONSTRUCTION: 15.
Sq. Ft. 1st Floor:
16.
VALUE OF CONSTRUCTION: $ ( coo
The value of construction is used to determine the amount ofpermit 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 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
CERTIFICATION:.
OWNER INFORMATION
NAME:
ADDRESS:
� l�Lolo\VIEYGF56N� �0fl .
.CITY: YOtIC,� CjtAtwT LO C//��1 STATE: 7rn 3y°16�f
PHONE (DAYTIME): 3E3 3 • "1 S email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FELL IN NAME AND ADDRESSBELOW_ ,- \
FEE SIMPLE TITLEHOLDER -
ADDRESS:
CITY: STATE: ZIP ,
PHONE (DAYTIME):
2 . : s i131:1 �ITTIJ1_llt [al
ST, of FL REG./CERT #:
1 (A
ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
STATE:
ZIP
PHONE (DAYTIME):
()
FAX NO.
email:
ARCHIT/ENGINEER:
ADDRESS:
CITY:
STATE:
ZIP
PHONE (DAYTIME):
wI
BONDING COMPANY:
ADDRESS: ,
CITY:
STATE:
ZIP
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MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
ZIP
IMPORTANT NOTICE: When a permit is issued"and it I,s not picked up within 60 days after notification
it will be voided and returned to you by mail.
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.
STATE OF FLORIDA ``
COUNTY OF . h.k /if Je
The foregoing instrument was ac owledged
before me this?X day of 0, 2046by
, who is personally
known to me or who has produced
rz"14r'dVe5 4,ef, , as identification
Signatur of Notary
or
Commission No.
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this _ day of , 20� by
who is personally
known to me or who has produced
as identification.
Signature of Notary
Type or Print Name of Notary
Commission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN__
THIS APPLICATION IN -THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.