HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY* ,q.f
{DATE FILED: 1 l . L S: v _ / .
PLAN REVIEW FEE: RECEtPr NO.: S & g-a2
CONCURRENCY FEE: RECEIPT NO_:
PERMIT NUMBER-
CERT. CAP. NO.-
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County Building and Zoning
a 2300 Virginia Avenue
< R10 Ft. Pierce, FL34982-5652 SCANNED
772-462-1553
BY
St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1. LOCATION/SITE
2. PROJECT
PROJECT INFORMATION
aJ ft
I n.vt G. %in,
SITE PLAN NAME:
3. PROPERTY TAX ID #: *26 -M-aD 20 -000- y
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
.578
9. PARCEL SIZE (ACRES/SQ FT.): 'Z s, 7-z, S F LOT DIMENSIONS:
a, 7,
A/O%A SduAAe-WI—
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
P
11. SETBACKS (ACTUAL)FRONT: Z(e.a7 BACK: 1.'t'
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
13.
14.
16.
[ ] NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
RIGHT SIDE: I S LEFT SIDE: Z Z. a b
[ ] EXPANSION/ADDITION
[ ] COMMERCIAL
[✓J INTERIOR RENOVATION
[I INDUSTRIAL
DESCRIPTION OFPROPOSED USE: V"Oor1,2e) to hftRA Ay a�g�y V-Izbr %Ap.
SQ. FT OF CONSTRUCTION: dG 15. SF. FT 1st FLOOR: Z G 4/
VALUE OF CONSTRUCTION: $ 191600
The value of construction is used to determine the amount of permit fees to be assessed. St, Incie County mores the right to question and/or modify the indicated
value of consuuction if it is demonstrated that the submitted figures are not eansistem with smdlartypes of conswctioo activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02 (% up
OWNER INFORMATION
NAME: GDtAaRa Stjw
Spy t MAa
.ADDRESS: l51-1 Ldr P-Q0D9 y�1c2aPft
CITY: �y C y I STATE: FL ZIP: 3 `9 90
PHONE(DAYTIME): C!7—zj 77G-0705' Email: N/AF
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME): (�
CONTRACTOR INFORMATION
STATE:
ZIP.
ST. of FL REG.CERT #: ",,ZWC/ ZSS3 n ST. LUCIE COUNTY CERT #:
BUSINESS NAME: OAAAL J-; ,(3z;± Hf a LCC°
QUALIFIERS NAME:
ADDRESS: 25'03 .fw ScerreW 71.�i
CITY: � /:X. STATE: /�z ZIP: 3 4:`5r7
PHONE (DAYTIME): (7701 2 LE /ice FAX NO.(77 - )2 9'7-51010 Email: /c&
ARCHIT/ENGINEER: �/ A�LJ I?R/1 ,w
ADDRESS: M17L'Jedry l �v✓e
CITY: S'rw?A
PHONE (DAYTIME): 77z 7 k7 lf7J d
BONDING COMPANY:
ADDRESS:
CITY:
STATE: /CG ZIP:
STATE:
MORTGAGE LENDER:
ADDRESS:
CITY: STATE:
0"
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 61) days after notification
it will be voided and returned to you by mail.