HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSGANt1E.9
OF CE USE;ONL_Y: 2 jt Lucie Count/
DATE FILED: 'Y
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: ,c RECEIPT NO.:
PERMIT NUMBER: c/ z
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
/ � U Ft. Pierce, FL 34982-5652
® N a� +"�� 772-462-1553 , 1
APPLICATION for BUILDING PERMIT SCANN
CERTIFICATE of CAPACITY/ZONING COMPLIANCE8t.LUCe (
INFORMATION
1. LOCATION/SITE
2. PROJECT NAME: CuWVwt o SITE PLAN NAME:
3. PROPERTY TAX ID #: A29 s 4& ^ 00
4. LEGAL DESCRIPTION (attach extra sheets if necessary): K\ NJtZYO I'l+ I ifinek fir IL
5. PLAT BOOK 6. PAGE N 7. BLOCK NO. 8. LOT NO.
2.2
—� q 9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: B(J SZ
10. COMPLETE DI�SCRIPTIC)N OF CONSTPUCTION PROJECT OR Wr RK ACTIVITY:J'It `� S
11. SETBACKS (ACTUAL) FRONT: oo�
RIGHT SIDE: (0/ LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate box4j —
Vf NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY) ,
13.
14.
16.
DESCRIPTION OF PROPOSED USE:
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
SQ. FT OF CONSTRUCTION: �� Q 15. SF. F)L FLOOR: ZS 1(J
VALUE OF CONSTRUCTION: $ �1 / i 610 0
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 am 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
UPDATED 6125/09
OWNER INFORMATION I
NAME: _ 'I -rp IC4 Y�i�IN ?A1 )44MA6
ADDRESS: A C /�L�V— ?L I.
CITY: M vxY 1t- roum—. STATE: G ZIP: 11-1
PHONE (DAYTIME): d% 3 JD 1 Email: jh 1 wwro.' iN, 490
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): L_) /
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: 61
ST. LUCIE COUNTY CERT #:
BUSINESS NAME: It4r,L:
QUALIFIERS NAME:
ADDRESS: E TrAA13 `lU V
p/
CITY: STATE: ZIP:
PHONE (DAYTIME): A Z /� 0 d FAX NO.
l �
-/
O / p / Email: Des
ARCHIT/ENGINEER: G
ADDRESS:
CITY: STATE:
ZIP:
PHONE (DAYTIME):Vu 7' Z 8
BONDING COMPANY: la l Yp
ADDRESS:
CITY: STATE:
ZIP:
MORTGAGE LENDER: I Ufi
ADDRESS:
CITY: 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, 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 concurency 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.
4
R CONTRACTOR SIGNATURE
S E OF FLORIDM
LINTY OF /// A a 7/
The foregoing instrument was acknowledged before
me this (_�oday of A JJ 20 13
by �A1n yuC I,'A&t6z-4p
who is personally known_ or has produced
as identification.
Signature of Nota — r
Commission No. 6 65'_ b� G a✓j-�,
(Seal)
STATE FFLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this y ofr�1�� OJ . 20 (,
by T6.,4 J In c /-JJAJ 04V J/_
who is personally known; or has produced
as identification.
Signature of Notary
Commission No. 6EQ 966.Z3 (Seal)
AUDREY K KLEMCZ4
NOTE: TWO (2) dt�iQg$�K61. ACH SIGNATURE MUST B�� R
THIS BU gROVihVNE UILDER, THE OWNER MU Y' S N
THIS AP D ON THE FRONT OF THI A NuTmyrina® ;8D00W01a
OWNER BUH.DERAFFIDAVITWH QUIREDFORALLOWNE
For specific instructions see appropriate permit checklist., .
AUDREYK.'
AOCQ,. AUDRE'IK.KENICZAK
10
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DATE SENT TO ADDRESSING: M / 1R/ 1:�)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER.
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
/
Io
I�
RECEIVEDTE
DATE
COMPLETED
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IIPIAIS