HomeMy WebLinkAboutBuilding Permit Application P.01
JUN-08-2015 10:07
M
OFFICC:USIs OSU:
DATE FILED.
PLAN REVIEW FEE: RECEIPT NO.: PERMIT Ni`UlbI13ER —+.y
CONCURREN(:Y FEE: RECEIPT NO.: CERT.CAP. NO.,
ALL-INFO MUST BE COMPLE'T'E & FILLED IN TO BE ACCEPTED
PLANNING& DEVELOPMENT SERVICES DEPARTMENT
13UMDING&CODE REGULATIONS DIVISION
2300 Virginia Avcnue t'��J ��y
4
Ft.Piero~,FL 34582-5652 � � �J `�
772462-1553 �Q �• ry
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT IN ORMALTION
1. LOCATION/SITE ADDRESS: IJ :Try", Sri'� I L -
2. PROD ECT NAME: I (A, (�-}C-.t '� S�IITE-�P�L�AX NAM,EE:�
3. PROPERTY TAX ID 6:
4. LEGAL DESCRIPTION(attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEI,,SIZE(ACRES/SQ FL): _LOT DIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY � g9ACAJ Y 0 X If
1411-0-1 'erilliompr& )T
III SETBACKS(ACTUAL) FRONT:_ BACK._ RIGW SIDE-- LEFT SIDE:
12. TYPEOF CONSTRUCTION(Check all appropriate boxes)
[ ) NEWCONSTRUCTION [ ) EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDEI'MAL1 COMM1 RCIAL 1 [ 1 INDUSTRIAL.
1') �
THBR(SPECIFY) e- ? j
13. DESCRIPTION OF PROPOSED USE:
14. SQ.FT OF CONSTRUCTION: . 15. SF.IT 1st FLOOR:
16. VAL0E OF CONSTRUCTION: $
The value of construction ii 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 eonstntcnon Wit it is demonstrated that the submitted figures arc not consistent with similar typca bfcon5truction activities. If the valucis$2500 or more,a
RECORDPD Notii;e oECommencement must be submitted with this application,
SLCCDV Faron No.:001-02
MATED 6!25149
P.02
JUN-08-2016 10:08
CERTIRCATIOM
:
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, fir 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 performod 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 CONDJTIONIKRS,FENCES,ETC.,.not otherwise included with this building permit application.
St.Lucie County makes no reptesetitation 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. , I
The following building permit applications are exempt from undergoing a full concurrency review, mom 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 JMPROVEMENTS TO YOUR PROPERTY- A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POST13D ON THE JOASITEBIWORE 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 QMREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT,YOU PROMISE W
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
TFIR PERSON WHOSE PROPERTY IS SUBJECT TO ATTACFMNT,,
OWNER ORCONTRfffft SIG CONTRACTOR SIGNATURE
STATE Or FLORIDA STATE OF FLORIDA
COUNTY OF, COUNTY OF .5wn*
The foregoing instrument was acknowledged before* The foregoing instrument was acknowledged before
me this day ofs. tl'�. 20-6 me this day of 20_LC-
by QVI la to 1 21 by_
who is personally known or has produced who Is personally known or hasp' need
tl
291 fication. s E�Idend C
A2� V
Signature of Notary nature of Notary
NELEN DOWNING HELEN
14 NG
4�5k
Commission NO.Ma�-T S3[0N#FF 0M576Co mission No. ON 1)FF 03 s16
EXPIRES:JWy 21,2017 PubticUndarwr7ers
1300ded Tfn Nowt'Public Uridewam
NOTE: TWO(2)SIGNATURES ARE REQUIRED.*EACH SIGNATURE MUST BE,NOTARIZED. IFAPPLYING )FOR
THIS OUILDING PERMIT AS AN OWNER/BMLDEP"THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWN ER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERIMUILDER APPLICANTS.
For specific instructions see appropriate permit cheeldist.