HomeMy WebLinkAboutBuilding PermitOFFICE USE ONLY:DATE �/
PLAN REVIEWFEE: 0 RECEIPT NO.: e7& PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED l w
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
.
2Virginia Avenue Pie
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS: Li ? 90 L-3bT6(LSaN(a l,)py r'T • 17 F,ec s7 34519
2, PROJECT NAME: C.orhw,vrJ ►Iy 'Poo L SITE PLAN NAME: Uj zT&r WNL i�dDt.. t C.oLiA��
3. PROPERTY TAX ID #: Z 53 Z^ SO 0 ^ O 00 '7 - OO 0 / q
4. LEGAL DESCRIPTION (attach extra sheets if necessary): l/J/r"I'b—&SON (1 'PUD jPt.PT No.
T2-r, CT t..lo . Z (S 5C_.: 3 2 To -J 1-J 3 S 5 V-014G6 : 41 6
5. PLAT BOOK 4 Z " 3 4 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9.
10.
PARCEL SIZE (ACRES/SQ FT.): .31 A<-
(:13, 32o sF )
LOT DIMENSIONS: p) I X I ZO ,
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: COtisT'Lo G- t?00 x-
6 c.K_. C.,o f3 /O r i R.o 51 rL O-0 M S /•� "ib C'C' b— xeD 7 0T � 0 S A L- — L1j S
—i�\.00-1c Cj15Ty�'UCT10^> > UP4DGA , SA5MI5 plz)c
11. SETBACKS (ACTUAL) FRONT: 1 S' t BACK: Y8 ' RIGHT SIDE: L 6 t LEFT SIDE: Z° /
12, TYPE OF CONSTRUCTION (Check all appropriate boxes)
[y]/ NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ J INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: Co m r- V N
14. SQ. FT OF CONSTRUCTION. (0 5-A
le
i
S le ' Prot_ D6 c �C
16. VALUE OF CONSTRUCTION: S / S-O, 00-0 �
15. SF. FT 1st FLOOR: S 7e.
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 Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION
NAME: I�aTStt r.IL,��} Q,oA;cc �wIN9�S �sso� CP��l Rio TNo SUN2lS6 Cow►p�NteS
ADDRESS: 1 O (pl E: N DI A rr4 J',,3 i20 S J VIZ 2P0
CITY: "S Of %'I e''ti- STATE: - ZIP: 334-7.7
PHONE (DAYTIME): (52l)-703—(,+4-7 Email: JDyr-JNC'C3 SON ►2ISUOFMPRrVIC4.c1s»1
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:
PHONE (DAYTIME): (,)
CONTRACTOR INFORMATION
ZIP:
ST. of FL REG.CERT #: CGC '505') Z7 ST. LUCIE COUNTY CERT #: c
BUSINESS NAME: Ga---mu CPJS Wcra,J y,6 L
QUALIFIERS NAME: Cs2 4 a �d�k6ti�lsr
ADDRESS: -Fb BdX 6t3 17%4;—
CITY: -?"y�� 'rr • LA) <- i u STATE: ZIP: 3 y 5 `d
PHONE (DAYTIME): 2z 331-- 7 Zyd FAXNO.772- 79 -885'/ Email: G12-64 6",V6FL• corA-
ARCHIT/ENGINEER: AMM8V
ADDRESS: IRIS 7 6' ST
CITY:
PHONE (DAYTIME): ('73 -9-
BONDING COMPANY: t4I A
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE: f, L.
STATE:
STATE:
zip: 329 to c,
ZIP:
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.
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.
N �
G W ` D u
ell
I�►�,�
R OR CONTRACTOR SIGNATURE m TRACTOR SIGNATURE
o ua iE
STATE OF FLORIDA/) / a rE 6 TATE OF FLORIDA
COUNTY OF C G>l Jr :Lk OUNTY OF
The foregoing instrument was acknowledged before o he foregoing instrument was acknowledged before
me this day of �' 20 /, e this day of 20
by
Cd
awe'
w o is personally own or has produced a 12
a who is personal) ow or has produced
as identification. as identification.
CL
W1
Signature of NoUry Signature of No a
0. •...
Commission No. (Seal) = Commission No. (Seal)
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.
a
r-i
OFFICE USE ONLY BP #:
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
I sr FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
RADON
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF
ELECTRIC GAS
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE, SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
/
INITIALS
4 i
i
CERTIFICATION OF COMPLIANCE
FLORIDA AMERICANS WITH DISABILITIES
ACCESSIBILITY IMPLEMENTATION ACT
AS CITED IN CHAPTER 553, PART II
FLORIDA STATUTES
By this instrument, I hereby certify that, to the best of my knowledge and belief, the following described project
complies with the Florida Americans With Disabilities Accessibility Implementation Act.
Project Name: Pool House, Wa t e r s o n g Conmu p i t y
Project Address: 4890 Wa t e r s o n g Way, Pt St Lucie, FL
I further swear and affirm that the plans and specifications submitted for review conform to applicable sections of
this code as they apply to this project.
Signed, sealed and delivered this da of - Z/l �� , 201=�3
Architect/Engineer S F A
• 0
7FWIR T Y
L O R I D A
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
#2537,-SSo0- 0o07- 000"`( WATGAZO jI n POD PLAT N6 . 0t-J ,Ti20(.T N0, z,
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
SOScvN A. KQvs6 -Fofz Wpr6aso►�h}�oP6Q.TIE+S �1►��-�4zsoc,A�,o►.1�Ll.L
Property Owner Name (Please Print)
1-28-13
opertf Owner Signature Date
STATE OF FLORIDA, COUNTY OF S T . WCtc
ACKNOWLEDGED BEFORE ME THIS 2,a7r- DAY OF TAPJ i A
NICOLE MCGUIRE
Notary Public - Slate of Florida
My Comm. Expires Jan 218, 2015
Commission # EE 47830
BY SOSG P 4 A q . K 9-0&16 WHO IS PERSONALLY KNOWN TOME OR WHO HAS
PRODUCED AS IDENTIFICATION.
NOTARY PUE
�4)—COMMISSION NUMBER
SLCPDSD Revised 08/24/2010
TYPE OR PRINT NOTARY
(SEAL)