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DATE FH.ED: � 7 - - g� - -- - -
PLAN REVIEW FEE: RECEIPT NO.: �� � t t � PERMIT NUMBER: f D�
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP_ NO.:
ALL INFO MUST BE COMPLETE & FILLED_ IN TO BE ACCEPTED
St. Lucie County Building and Zoning
1oRlo SCANNED 2300 Ft Pierce, Virginia
825652 (�
BY 772462-1553�
- St. Lucie Cnitnttr
APPLICATION for BUILDING PERMIT
CERTIII'ICATE of CAPACITY/ZONING COMPLIANCES
PROJECT INFORMATION
�p 7 �L%Z
1. LOCATION/SITE ADDRESS; Sop ( � /ae? v� �� O
2. S/D NAME: FLPe Z voo C ee-(Y SITE PLAN NAME: .
3. PROPERTY TAX ID#:a94XOD-e/%� i9, -AOP-9W&7-3 /-
4_ LEGAL DESCRIPTION (attach extra sheets if necessary): FLeel u/��t/ !i(C'/Z P�� �/� �� 'eq'�
5. PLAT BOOK ✓�� 6 NO.PAGEO:]W,3 7.NOO. 3 22 S. NO.
O
9. PARCEL SIZE: ACRES/SQ FT. A 1&'eALOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
] 1. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT:
IV IA- _ Wei SIDE � SIDE N /1
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDMON [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ J INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: C & V _
14. - Sq. FtJCONSTRUCTION:�Iow 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: $ O
The value of construction is used to determine the amount ofpermit 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 submittedSguns are not consistent with smrlar types ofconstmWon activities. If the value is $2500 or more, a
RECORDED Notice of Commencement most be submitted with this application.
SLCCDV Form No.: 001-02
CERTIFICATION:
OWNER INFORM TI/ON
NAME: 9/—? i ,' " V 0 V
ADDRESS: ; C� o p / ;,zc?
CITY: �gO2 %L %P//P�// ppP STATE: ZIP` U
PHONE (DAYTIME): Z� y dC7 iC S b email•'
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 REGJCERT #: ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: ZIP
PHONE (DAYTIME): n FAX
NO. /Q email:
ARCHIT/ENGINEER:' / P % �`� / ` C6FX
ADDRESS: ^ �
CITY: STATE: ZIP �O
PHONE (DAYTIME): ��� 7` ` - �S /
BONDING COMPANY:
ADDRESS: .
CITY: STATE: ZIP
MORTGAGE LENDER -
ADDRESS:
CITY: STATE: 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 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, 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 YOURNOTICE 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 and zoning.
EWCONTRACTOR SIG0ATURE CONTRACTOR SIGNATURE
STATE OF FLORID ,,
COUNTY OF r U U.0
The foregoine instrument was acknowled
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me this _ day of,
to me or
20� by
is personally
identification.
(iC/ C�1{RY PUT tC.ST.ATF OF FLORIDA
Typ or PrintNameofN r Gr^7 7 (pyeochea Type or rintName ofNotary
Commission No_.. Seal a'a 01, 2007
(Seal) ci�,�;=c; ji![y Commi sionNo. (Seal)
BONDED THRU i L,. ,1USUNG CO., INC. -
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST'BE NOTARIZED. IF APPLYING FOR
THIS BUH.ING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN_
THIS APPLICATION IN.THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.