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HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT%T"' `4 t LOT SPLIT APPROVED ' ITT f43'�.'J}" 3 M�� �::R- kt2i-z[_ I�`F z��.e�.Axs_��','_a� „i4ry 'i''� f'.R•L_„e''�-'i.� Yi"C . _.."�is"_.t� �l 'Y :? '���f..-NA'3 h itla.....�'4*=2 t �. F� l vY 1�3 k': ...c .�' i:'�aa•, �=�`�'".s �'�i � -- :.sd3,.. ,u,4�.=�..�`�'�'-�r7"�����. .�'�.�a:��v��°'�..�vu�sj I'� REPORT •• + M-11 ••• JTABLE AREA Nwa ,• •• r ©®r:TOTAL ADDITIONAL ®® REQUIRED �&M�F�0 ® ®® DATEREVIEW J p( �v 363 PERMITNUMBER: D� Vv -y 55 I PLAN REVIEW FEE: /QO � RECEIPT NO.: CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St. Lucie County Building and Zonin:I:e= 2300 Virginia Avenue \x SCANNED c�OR1D Ft. Pierce, FL 34982-5652 B� 772462-1553 St. Lucie County APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION �✓ 1. LOCATION/SITE 3 D / E�� 2�c�QU2 2. S/D NAME: FLiw/Ape SITE PLAN NAME: 3. PROPERTYTAXID#: �`f� ����—���+`��B1Bfl�� 4. LEGAL DESCRIPTION (attach extra sheets if necessary): CL " we- � / e BPS /0/- X f � 5. PLAT 6. PAGE 7. BLOCK ✓ 8. LOT . fir V BOOK NO. D 3 NO. 3 NO. 9. PARCEL SIZE: ACRES/SQ Fr. D r HMV L . ~OTDIMENSIONS 0 �Y y /` /0 e2. O%" Q C �,L 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: C�2P/E < / ✓ U 11. SETBACKS F (ACTUAL)/\ FRONT- ACK: �? .. RIGHT: �/ 17 IDES 12. TYPE STGT RUIO (Check all appropriate boxes) &a 'NEW CONSTRUCTION EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL I] COMMERCIAL [ ] INDUSTRIAL [ l OTHER (SPECIF)) 13. DESCRIPTION OF PROPOSED USE: 14. Sq. WCONSTRUCTION: Sq. Ft. lst Floor: 16. VALUE OF CONSTRUCTION: $ oL 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 submitted figures are not consistent with similar types ofconstruction activities. If the value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 CERTIFICATION: OWNER INFORMATION CITY: j' O`/_2/I2.c �/ Si'A:lr: /' /�- LIr PHONE (DAYTIME): dCP�o�—� 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 #: BUSINESS NAME: QUALIFIERS NAME: _ ADDRESS: CITY: PHONE (DAYTIME): ARCHIT/ENGINEER:' ADDRESS: CITY: PHONE (DAYTIME): I BONDING, COMPANY: ADDRESS: CITY: MORTGAGE LENDER- () FAX NO. STATE: STATE: ST. LUCIE COUNTY CERT #: ZIP email: ZIP ZIP ADDRESS: CITY: STATE: ZIP IWORTANT 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 CONDMONERS, 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 YOUR NOTICE 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/incomplice with all applicable laws regulating constriction and zoning. ER/CONTRACTOR SIGN RE CONTRACTOR SIGNATUR STATE OF FLOJOPA 1, / STATE OF FLORIDA COUNTY OF uG COUNTY OF The personally Signa tary�� Type or Print Name of - ";.k_, Commission NOTE: TWO (2) SIGNATURES Alit THIS BUH.ING PERMIT -AS. THIS APPLICATION INTTHE The foregoing instrument y&s acknowledged before me this _ day of— 20� by who is personally known to me or who as produced as identification. or No. (Seal) -H SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR ,DER, THE OWNER MUST PERSONALLY APPEAR TO SIGN_ ON THE FRONT OF THE APPLICATION. For specific instructions see appropriate permit checklist.