HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY:
DATE FILED: l
PLAN REVIEW FEE:
RECEIPT NO.:
CONCURRENCY FEE:
RECEIPT NO.:
PERMIT NUMBER: I GC�
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES TMENT
BUILDING & CODE REGULATIONS D I I IDS OME r,,d
SCANNED 2300 Virginia Avenue
Ft. Pierce, FL 34982-5652 JU�f 9 7 2�tii
BY 772462-1553
St. Lucie Count, Public Wo,$,s
St, Lucie Courq,, FL
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT
CnbI
1. LOCATION/STI'E ADDRESS: Qeserve Blvd N
2. PROJECT NAME: MLUA QC1-] d rPC�7ITE
3. PROPERTY TAX ID #: 33a7- QXb- OOOS,
4. LEGAL DESCRIPTION (attach extra sheets if necessary)
5. PLAT BOOK 6. PAGE NO.
9.
10.
PARCEL SIZE (ACRES/SQ FT.):
COMPLETE DESCRIPTION OF CONSTRUCTION
�
hbmnd j usi- eos+ o-F I etler Wi lYcurs en
PLANNAME: PE7XVIIIQ(C PbA.
7. BLOCK NO. 8. LOT NO.
LOT DIMENSIONS:
OR WORK ACTIVITY: Yl^ 8l 1
I1. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE:
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
LEFT SIDE:
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
14. SQ. FT OF CONSTRUCTION: _ _2 ! S t' 15. SF. FT 1st FLOOR
16. VALUE OF CONSTRUCTION: $ (PC�O. OZi
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 constmcdon activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 025109
OWNER INFORMATION
NAME: PGA VI IlQrip TtR
ADDRESS: 2140 2e�&Ve +�zrlG -rMce-
CITY'-T�f-� Sfi L.L 6.ke, STATE: GL
PHONE (DAYTIME): L__) '4 W-7-1 f5CX3 Email-F�5%a&i6n
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER -
ADDRESS:
CITY: STATE:
PHONE (DAYTIME): ()
CONTRACTOR INFORMATION
ZIP:
ABOVE, PLEASE
ST. of FL REG.CERT #: C- S12c'O 13 tOO ST. LUCIE COUNTY CERT #:
BUSINESS NAME: TG I nc, .
QUALIFIERS NAME: E u=ri� L]00&r^li M�Cr
ADDRESS: 1 bzz-9 I krwtQ.Ni�
CITY: Pblr+ 15�- ULL6-C STATE: Fl- ZIP: 23'SQ52___
PHONE(DAYTIME): M2-) 335-2-y41 FAXNO. 337-C &01,- Email: slgncMnrcilbj. x @
hakyidl l • cove^
ARCHIT/ENGINEER
ADDRESS:
CITY:
PHONE (DAY FIME): L—)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP:
M
M_I'
BIPORTANT 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 concurency 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
COUNTY OF Z 9i- LLtC Ie
The foregoing instrument was acknowledged before
me this 15 day of JL4)e_ 0) (e,
by ili )af�d LwA c.rba cIL
who is personally known ✓ or has produced
as identification.
Sig . ture of Notary
CONTRACTOR SIGNATURE
STATE OF FLORID t I
COUNTY OF 1_l
The foregoing instrument was acknowledged before
methis ��day Jof �,-I1.11�e_—,.,'/,20 (
by & 11YIM 1.nUF`IX./ I.�tttk
who is personally known or has produced
as identification.
Sign. ture of Notary
Commission No. Commission No —COq k�:(��TINq L LOUDEI
KRISTINA L LOUDERBACK 1nt "' MY COMMISSION #FF
'i MY COMMISSION #FF009222
t< .,_,.„„ EXPIRES August 7. p
EXPIRES August 7. 2017 � 3it&Ots3 Flor
NOTE: TWO (2) SIGNAlE Rlp{ 93eK4.gq SK NATURE MUST BE NOTARIZED. s
THIS BUILDING 0111,13ETE, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNERBUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.