HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSECTION: TOWNSHIP:
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Yale cpGy ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
SCANNED
'2DR1� FORT PIERCE' FL-34982-5652
561-462-1553 B T
St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
PROPERTY TAX ID #:�
LEGAL DESCRIPTION (attach extra sheets if necessary): LxA-N\1G�
5. .-PLAT, 6. PAGE 7. 8: 'LOT
BOOK y� NO. NO. _ n NO.
'_ -6qj g(,D
9. PARCEL SIZE: Q FT. `8��• LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: BACK: m RIGHT
SIDE
LEFT
(o,�G SIDE: .�
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
jD4 NEW CONSTRUCTION [ ] EXPANSION/ADDITION [
] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [
] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: ' 1�EStD6t1Z t F4L
1
J 14. Sq. Ft./CONSTRUCTION: <31 15. Sq. Ft. 1st Floor.
'I
16. VALUE OF CONSTRUCTION: $ L� 4�
The value of construction is used to determine the amount of permit fees to be assessed. SL 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 withsimilar 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
OWNER INFORMATION: I I
NAME: tZ�.S'z.R�ll` �-FOtKS.S LTA L P
ADDRESS: - 1(00( �61ZLP,f)'�. '�. -.. aUc-VP
CITY:
PHONE (DAYTIME):
3-M L1 -- Seoo
STATE: r' L ZIP 33 H..O (
'F THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
3ELOW.
:EE SIMPLE TITLEHOLDER: K i A
\DDRESS:
:ITY:
'HONE (DAYTIME):
STATE:
:ONTRACTORINFORMATION
IT. of FL REG./CERT #: ST. LUCIE COUNTY CERT #:
ZIP
IUSINESS NAME:
5t�n1AT u.F2L
H6MrS
INC_
IUALIFIERS NAME:
1K7OLZ'ER
�RoStiycy J
ADDRESS:
- 21�0 ht }Zg5@tZVl3. PAizk(
tZe4CE
:ITY:
>5F,T 57V LAC-- l>`
STATE:
FL ZIP
HONE (DAYTIME):
-(772-) R6 3
FAX NO.
•(p�3 - -r�'1 L�
RCHIT/ENGINEER:
sccf�-T[- S big. H F_R
DDRESS:
y oO _ )-j lGppFi {� r ��g
�6A�
S L> cr-� (G1p
ITY:`(N,•TOt�(
DZ
.U�ACI�
STATE:
- FL "' "ZIP'"
HONE (DAYTIME):
7NDING COMPANY:
)DRESS:
TY:
)RTGAGE LENDER:
)DRESS:
rY:
STATE: ZIP
NIA
STATE: " ZIP
WORTANT NOTICE: When a permit is issued and it is not picked up within 60 days
Fter 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, 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 z
7=��a_ p--t_
OWNER/CONT TOR IGNATURE CONTRACT SIGNA RE
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sr LLkr-t c COUNTY OF Sr LLie_n-
f �
The forego I s ment was acknowledg d The foregoing ins ment as acknowledged
before me this day oftaown
byj � before me I is � ay of , 20d�, by
o Is persona yto me rwho n to me
as pr ce ntification. or who as produced as identification.
i nature of Notary *i(ature of Notary
Type or Print Name of Notary Type of Print Name of Notary
Notary Public Tibe N t P lic Title
CD
comm0#�REDI>232a58 Com'nissinn
(seal) Fxptresg12312DDT LYNMOORE
Co mDD0
432+t254 m# D02S2858
(seal)
Bonded iluu (800) Expires 3123l2007
Florida Nota Assn.. Inc. Bonded thru (800)432-4254
Florida Notant Assn., Inc.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNE13/BUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.