HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY yA' #:
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OFFICE USE ONLY:
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
L\E Cp -
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J St. Lucie County Building and Zoning
2300 Virginia Avenue By
/OR104' Ft. Pierce, FL 34982-5652 St LUdP rnnnfi,
561462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
I. LOCATION/SIIT!E ADDRESS: 2 q 1 Z%rS AIl AsI� ra
2. S/D NAME: &;50CL r STA'7F SITE PLAN NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT 6. PAGE 7: BLOCK 8.LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: /�L�C.� �✓ cyz-iy
Lcrs F CAF c mnlz,y
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT:
SIDE SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL {�] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: 991006C �5-WCl r4-0OF.1 Y OA4e"K
(j RA.AkO (A! 0/4A/
14. Sq. FUCONSTRUCTION: 15. Sq. Ft. IstFloor:
16. VALUE OF CONSTRUCTION: $ 10494.. epo
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 are not consistent with similar pw of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
CERTIFICATION:
OWNER INFORMATION
NAME: Sv r��<2 S Tb✓� IDE T/ZOC /l�I.w !n/G , _
ADDRESS:_�j2-.Z_!—G(l.—QT-L�OrtITIG--�G///7.-- -- - - --
CITY: h444 6A-TE STATE: FL ZIP 3aG3
PHONE (DAYTRAE):
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: E' r ODDO (O 7 ST. LUCIE COUNTY CERT #: `/ S 3
BUSINESS NAME: Gv c,, LSD S t arms , rAt6,
QUALIFIERS NAME: k0& t4 4G00 Z, &O-VZ 0
ADDRESS: 36 Ss, 6 In
CITY: STATE: t-(_ ZIP
PHONE (DAYTIME):. (772) 2$ 3 ' yGls// FAX NO. 77,2 - ,RrY 3 &/' icy email:
ARCHIT/ENGINEER
ADDRESS:
CITY:
PHONE (DAYTIME): L
BONDING COMPANY:
ADDRESS:
STATE:
CITY: STATE:
MORTGAGE LENDER: KA
ADDRESS:
CITY:
STATE:
FM
A
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.
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 oFapermit and thaYall -
work-willbe-performed-to-meet the-standa ds of all_l ws 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 a oning.
OWNER/CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLORIDA STATE OF FLOR A
COUNTY OF COUNTY OF /�/ a Y
The foregoing instrument was acknowledged The foregoing instrument was acknowledged
before me this _ day of. 20_, by before me this Loay of Jeu l , 20,ff by
who is personally who is personally
known to me or who has produced known to me or who has produced
as identification. .rL x, L as identification.
Signature of Notary
Type or Print Name of Notary
Commission No. (Seal)
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.
Fors specific instructions see appropriate ermit checklist. �M'+'✓••,, =R.AMESMESPP � `OANotaof Florida_ MVC0Nav 7, 2008�®Co335396BondeotarVAun.