HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONF--
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"NIr•SY: t•!TNCHIP CONSTRUCTION; 772 545 2211;
t
MAY-25-05 7:12; PAGE 3
OFFICT, USE QNI Y:
DATE FILED: S'd(oS
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
—CONC=URRENCYFEE: — RECEIPT NO.: CERT_CAP. NO.:
ALL INFO ]1lUST BE S^ FILLED IN O BE ACCEPTED IS
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St. Lucie Co my wilding oning �pt�
2300 Virginia Avenue
982-56 SCANNED
Ft. Picttc, PI.3S482•SG52 SCANNED
772-462-1553 BY
Sf. LUCieCoOnt%
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFO&MAT,I/ON / z
L LOCATIONISITE ADDRESS:
2. S•`D NAME: SITE PLAN NAME.
3. PROPERTY TAT ID #' 1n
4. I.F.GAL DESCRIPTION (attach extra sheets if necessary): �-4..
5
9.
I0
11.
I?.
PLAT 6. PA(E , 7. ALOCK
BOOK NO. NO.
PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS _
DESCRIPTIOHF CONSTRUCTION PROJECTOR WORK ACTIVI7
SETBACKS (AC-fUAL) FRONT:
_ d-o44- w
BACK: RIGHT.
_ SIDE _
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
] J RESIDENTIAL [ ] COMMERCIAL
(] CYI'FIER (SPECIFY)
S. LOT
Nt:
LEFT:
SIDE
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
13. DESCRIPTION OF PROPOSED USE:
14 Sy. Ft.r(:ONSTRUCTION:_y�,[
.1 `�L — 15. Sq. Ft. Ist Floor:
I6 VALUE OF CONSTRUCTION: $ �
The value of ounsl0101011 is used to delennim the amount ul permit fees to be asseoscJ. St. Lace County the ngat 10 quauon 311&01 nndtty the indicated
value of uif it is damomarawd tbut the sobmmed figures rare ram con.i%tent with similar types n1'umstmaion uetiviUes If the value is S3500 or mom. a
KWORDED Notice or Commencement must bss.uhntined with this application.
SLCCDV Form No.: 001.02
Vlk ,) -
'ENTw: PlINCHIP CONSTRUCTION; 772 545 2211;
MAY-25=o� 7:12; PAGE 4/10
OWN
INFORMATION
SCANNED
BY
St. Lucia f .rnm$►6
ADDRES'S: 0,6,9)c
/6 1i
CITY: )� f4 To STATE: ZIP
PHONE (DAYTIME):
IF THE PER SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFPERE.NT FROM THE OWNER LISTED ABOVE, ?LEASE
FILL 1N NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY` STATE: ZIP
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION o
ST. of FL REG.tCr•.RT tt/: a���/l B 7 63 7o�i ST. LUCIE COUNTY CERT
BUSINESS NAMV: ( 6�/91-5 T 'Glnl�d &'S eS -ZNct _ ..
QUALIFIERS NAME -
ADDRESS; �i4/✓'9� EE T �C/� y n
CITY. � _���q STATE: �L ZIP -.?Cf �
PHONE (DAYTIME): {_/J� j`s°2/-�qo9 FAX NO. JZ'��� -1 i77 email:
ARCHIT/ENGINEER
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY -
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP
ZIP
ZIP
iNiPORTANT 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.
f
ENT S_Y: :^InIrHIP CONSTRUCTION; 772 545 221l; MAY-25-05 7:12; PAGE 5/10
CERTIFICATION: SGAMW
BY
Sg, LUCIP• Cminh
This application is hereby made to obtain a permit to the work and mstahahons as ink xRG and-to-obtainvicenificate-of capacity,
if applicable, for the permitted work. I certify that nu work or installation has commenced prior to the issuance of a permit and that all
work will be performed tu meet the standards of all laws regulating construction in this jurisdiction. 1 understand that separate permits
may be required for FI•RCTRICAL, 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 front undergoing a full concurrcncy review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential mc.
NOTICE TO OWNER: FAILURR 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 I IS NOT YOUR RjQHT TITLE,
AND INT REST THAT 1S SUBJ£CT•.fO rr\TTACHMF.NT: 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 ippijeahle laws regulating construction and zoning.
ffWN— ER,' ' U TRACTOR SIGNATURE 6-1CONTRACTOR SIGNATURE
STATE OF FLORJ
COUNTYOF -
The foregoing instrument was acknowledged
befarc me this a�e da • of 20(7�by
who rs
known to me ur who has produced
as identification
Signature of otary,
STATE OF FLORID
1
COUNTY OF Ld k e -A' D
The foregoing instrument was acknowledged
before me this�4 day ofA6a"t. 2t�, by
who ion y
known to me or who has produced
_as identification.
A—'1
Signature of olary
AYx'�GA`.w.p
yV YDER TY=_*EXF1lieS:
lutS ; X v if DO227155 SIASNYDER
EXPIRES:Juno26,20D7 ISSION6DDConu��l(IiF3cl, ao damn Naan•P,a (laal)l¢rs COSTune28,2007
ohry PubUc Unj mters
NOTE: TWO (2) SIGNATURES ARE REQUIRED, EACH SIGNATURE MUSTBE NOTARIZED. IF APPLYING FOR
THIS BUILING PERNIITAS AN OWNERIBVILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS .APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specifie instructions see appropriate permit checklist.