HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE U_SE ONLY: r
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER: lGcyo. --ySv7
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES[9j&a AR3T
BUILDING & CODE REGULATIONS DIVISION
2300VirginiaAvenue JUN 1 7 2016
SCANNED
Ft. Pierce, FL 34982-5652
BY 772462-1553 Public Works
St. Lucie Countv St. Lucie County, FL
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITEADDRESS:I 9004r Thcffip w olA+ 0,
2. PROJECT NAMEtS0L4hA0JC D%MtDa SITE PLAN NAME: A VI G FbR Z
3. PROPERTY TAX ID #: 93 ei 7 - $4 4 - OOCI - 000 - 7j
4. LEGAL DESCRIPTION (attach extra sheets if necessary): Ca o Qi10.0 h e-d
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO.
9. PARCEL SIZE (ACRES/SQ FT): LOT DIMENSIONS:
8. LOT NO.
10. COMPLETE' TIFSCRiPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: I ns+-o -I
_ Sian
11. SETBACKS (ACTUAL) FRONT: BACK:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION
RESIDENTIAL
OTHER (SPECIFY)
RIGHT SIDE:
LEFT SIDE:
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
13. DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION: _ 2-6 S.- f, 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $ ICDD.10
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 types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Cornmencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION
NAME:
CITY: POr+ &+ LLL6e- STATE: F. ZIP: 349$(e.
PHONE (DAYTIME): qT L (P7 - 1 5o3 Email: F l O-drn j n Iz 1"nianou
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE,
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME): (___)
CONTRACTOR INFORMATION
STATE: ZIP:
ST. of FL REG.CERT #: ESI2o013(00 ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERSNAME: L d.yuwt LVJatrbCtGL
ADDRESS: 1 OZ21 SE Uk IV)01Y rl\
CITY: 6✓ - a Lode. STATE: FL- ZIP: 34952
PHONE (DAYTIME): ML 357- L(OZD FAX NO. i72 -55j - C;60(o Email: $j�retnnCCJ}IbY1 ��@
• Yahm • 4crn
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER -
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP:
IlVIPORTANT 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,
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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLORIDA I
COUNTY OF S+ W C1 f
The foregoing instrument was acknowledged before
me this 15 day of JL>r)e, 20LL6_1
by Vfdwaina Laudc y1JcicX
who is personally known or has produced
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF S+ LL.GIt'
The foregoing instrument was acknowledged before
me this tL day of J LV)P— 20j
by �ckOar d C..c)dCX_13 LCy.
who is personally known -�/ or has produced
as identification. as identification.
Si nature of Notary c Sig ature of Notary
r .+..w,
Commission No.D0i22 i:f ""SISTINA L LDUDERBACK11(TINA L LOUDERI
Commission No. 'i�L"
f`q a MY COMMISSION #FF009222 i MY OMMISSION #FFO
EXPIRES August 7. 2017 EXPIRES August 7. 2(
40 398-0153 FloHdallotarySeNIMXOM (407) 398-0163 FloAdallotarySewimcc
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 APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.