HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
OFFICE USE'ONLY:
DATE FILED:
PLAN REVIEW FEE: QQ RECEIPT NO.: �[aos�O PERMIT NUMBER: o2�-lOD Z
Co—
ST. LUCIE COUNTY PUBLIC WORKS"
M BUILDING & ZONING -DEPARTMENT, ,
�l 00 v �5 k-1. �L(Y ('� FORT PIERCE, FL 349 2-5652 I I L
'2R10p U— 561 462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION '34i.9/ \
1. LOCATION/SITE ADDRESS: 31 as Rowivi as!" sTv �% pf,�t� Q (rt7953J
2. S/D NAME: I?Pit� %�'9l !ra s SITE PLAN NAME:OTO/O
3. PROPERTY TAX ID #: _H—AS — 602 — e0oa q — 6 7_... :. SCANNED
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5: 'PLAT .6."_10AGE 7. BLOCK 8. LOT
BOOK - : , NO. NO. r NO.
9. PARCEL SIZE: ACRES/SQ FT. 83 JZ2LOT,DIMENSION6
10. DESCRIPTION OF CONSTRUCTION PROJECT O'R-WORKACTIVITY: _i/V ij C�L S4gjz
11. SETBACKS (ACTUAL)
' "FRONT-. t
' ` '
BACK:
A11A
RIGHT
SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
�] NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
[ ] EXPANSION/ADDITION
�] COMMERCIAL
13. DESCRIPTION OF PROPOSED USE:
14. Sq. FUCONSTRUCTION:
LEFT
SIDE:
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
15. Sq. FL 1st Floor goo o • sT
16. VALUE OF CONSTRUCTION: $ r o DO
The value of construction is used to determine the amount of permit fees to be assessed. SL 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 simiiar.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
THE AVERAGE PROCESSING TIME FOR MOST` 'll-DING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME: l7- 1GK@QSo� op YLoE.%OA , 1—
AG-ADDRESS: 1 P. -I1 °I
CITY: ST STATE: ZIP `b99°15
PHONE (DAYTIME): _1111 66 a
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: Atl�►-
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
STATE:
LP
ST. of FL REGJCERT M C.G C-O'�4O69j ST. LUCIE COUNTY CERT #:
BUSINESS NAME:— A.,I o say- C.ONs2uG10rl CeVj%9rQ-1
QUALIFIERS NAME: DOAtALO L. %OLLVTTL
ADDRESS:
_\AO\ M—A N\ A
s') AC `. ,O1
CITY:
r7
rQ0 \ AeoA
STATE: 7toQ\04 ZIP 3' G-*Z�
PHONE (DAYTIME):
`.Z?�A.91
FAX NO. )"'4. rJ34. Fj1bS
ARCHIT/ENGINEER:
W�-� W f•_L 5FZ�,
ADDRESS:
1�'
�L. C-F'
CITY:
f`105
STATE: `i-o ¢-\ O A ZIP 29,9 60
PHONE (DAYTIME):
f71, �-i0• Q')O�
>rA.�'7'77,.-170 4(oL}O
BONDING COMPANY:
,1/1
w �iti
ADDRESS:
CITY:
STATE: ZIP
MORTGAGE LENDER:
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, ff 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 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: 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
j[[[ with all applicable laws regulating construction and zoning.
OWN CONTRACTOR SIGNATURE CO 1 NATURE
n
STATE OF FL RID STATE OF FLORIDA
I COUNTY OFJJ� COUNTY OF�rJ
The foregoing fn trumeq as acknow a The foregoing instrument was acknowledged
before m this �P day o7 �0U , by� befgrg me this f day of � 20o b
G rho is ersohall own to me or ho • /1 A �' y
Awho is personally known to me
has or
as identification. �asadeRtifieation
�Ignatur o Clary S mat of ota -
�JAIJ L.Frf �v q ins
Type or Print Name of Notary Type of Print am
Notary Public Title
Notary PublicTitle
Commission Numb D 30'( 85o�Commission Number
JANET�otl�� ER
(seal) My =Er=tai zoos (seal) ?v A HWm
my Comndutm DD23MS
�►,,, p� Expires November 19.2007
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 APPEAF
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.