HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICEUSE'ONLY:DATE FILED-.-
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PLAN REVIEW FEE: •, RECEIPT NO.: �+ (3�yPERMITNUMBER: �rI/X��0Qj�(
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652 SCANNED
772462-1553 By
St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. ® LOCATION/STFEADDRESS: [ S�S� S &"edn dr,
2. ® PROJECT NAME: SITE PLAN NAME:
3. orPRoPERTYTAxJD#: a6-;zq-3y3-0003-000—,T'
4. ® LEGAL DESCRIPTION (attach extra sheets if necessary): � % 3 S q/ S aQ `e2 o r r O F (OV r L 0 r
K-Ll�s5 40f- (3,001k) C09238/-o2y07)
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): , sl LOT DIMENSIONS: ' - V, 3 3 K o? DO
10. 40 COMPLETE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: 9~04/e
L a-djer bo��ds rem/o�� /wv. h a d®udle 9K? Gealaer.
Use-- 19ety 5162a,'I)[e5S Sfwel /aSfene�S /1/�f9o:ny mufefa��s�ny fv&j;,
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
`[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION (] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[S,r OTHER (SPECIFY)
111 DESCRIPTION OF PROPOSED USE:oo.i s
14. 9 SQ. FT OF CONSTRUCTION: !U/R 15. SF. FT 1 st FLOOR
16. QVALUE OF CONSTRUCTION: $ «po0, 00
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 ifit is demonstrated that the submitted figures are not consistent with similar types of construction activities. if the value is $2500 or more, a
RECORDED Notice ofCommcnecmenl must be submitted with this application. •
SLCCDV Form No.: 001-02
t
UPDATED 6/25/09
OWNER INFORMATION
NAME: e4o/
®ADDRESS:
CITY: rs/` r / fr[ STATE: r z-1' ZIP: 3 Ci ! r{
PHONE (DAYTIME): C " 6199 - fall Email: �e��6ng /GLtom6l`rS @l7SN Gmh7
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:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: a % 3 3
BUSINESS NAME:
STATE:
ZIP:
C&C'(s k 4 g-s4 SS
ST. LUCIE COUNTY CERT #: iqj
■ QUALIFIERS NAME: _X o b e/'7 /'49n A O (O
ADDRESS: S* 6 f' 4 d
CITY: 7-e ct es 6a STATE: /:2 ZIP: 3 31 la 9'
PHONE (DAYTIME): (gj) ��f1-l/7Y FAX NO. S6(-7yf1-6W2f9 Email:
ARCHIT/ENGINEER h/ ty �,`O EAgi/7044,1
'oADDRESS: 5'.97.57- S®k li &,e217 a PorA;44
(DAYTIME):
BONDING COMPANY
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP: 3 34�Y
ZIP:
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.