HomeMy WebLinkAboutBuidling permit applicaitonG
OFFICE USE ONLY BP #:
SECTION TOWNSHIP
FRANGE MAP NO.
ZONING
LAND USE LOT CVG % TAZ NO.
FLOOD ZONE FIRM MAP # 1 sT FLR ELV MAX HGT
CONST TYPE .I / I .00CUP TYPE I `MAX OCCUP I I # OF FL RS
WATER I I SEWER I I SPRINKLERS I I STORMWATER
LOT OF REC I I LOT *OF 990 I I LOT SPLIT
I I LOT SPLIT
APPROVED
Before 1/1990 After 1/1990 1
REPORT
CODE
' c
f
�IITABLE
RADON FEE
FERENIIT
orn
PUBIC BID
IIviPACT
FEE
mn Al
PARKS
IIbi PACT
FEE
LIBRARY
INTACT.
FEE
.
PUBLIC BID
IMPACT FEE
CORRECTION
SCHOOL
IMPACT
FEE
ROAD: CREDIT
IMPACT
FEE
YJN
LAW ENF
IMPACT
FEE
'
FIRE/EMS
IMPACT
DRIVEWAY Y N DRIVEWAY
REQUIRED _FEE
ADMINISTRATIVE
VARIANCE FEE
FEE
_
MECHANIC ROOF NON -CONFORMING.
ELECTRIC GAS LOT OF RECORD
PLUMBING FEES
MISCELLANEOUS
_FEES
`
SPECIFY
SUBS
REQUIRED
DATE SENT TO ADDRESSING: 1 /
REVIEWS' - .:--,,FRONT ZONING SUPERVISOR PLANS :'; VEGETATION SEA TURTLE
.:CO R REVIEW REVIEW REV EW • .. .REVIEW REVIEW
DATE`
RECEIVED
DATE
COMPLETED_- _
INITIALS
• i
MANGROVE
REVIEW
1 �
OFFICE USE ONLY:
DATE FILED: �b RECEIPT NO.: SV PERMIT NUMBER Ir0�
pLAN REVIEW FEE: CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
-PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: F V V
2. PROJECT NAME: 1 I G2� 1t:� SITE PLAN NAME:
3. PROPERTY TAX ID #: 3 11�N "' �(7�� ✓00o &
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
r ,.
3Y%57
T'0
� 3
5. PLAT BOOK_ 6. PAGE NO. 7. BLOCK NO. 8. LOT
9. PARCEL SIZE (ACRES/SQ FT.): 6 . 6 5 4 61e3 LOT DIlVIENSIONS:. ,See kk 6c 6` A
10. COMPLETE DESG TI N 7.CONSTR
UCTION PROJECT R W RK ACTIV4cv1
1i_ 11. SE ACKS (ACTUAL) FRONT: 1► 9� ft BACK: � �"� "� Y RIGHT SIDE: L FT SD-
: 3' . J
12. TYP OF CONSTRTI.CTION (Check all appropriate boxes)
[ r CONSTRUCTION (` EXPANSION/ADDITION [.1 INTERIOR RENOVATION
[ RESIDENTIAL I ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) ff
ION OF PROPOSED USE:c�or— ' eXfs J I
I3. DESCRIPTION
14. SQ. FT OF CONSTRUCTION: J�"I 1 15. SF. FT 1st FLOOR 2
16. VALUE OF CONSTRUCTION: $ q5yI D L)D
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 Farm No.: 001-02 i
a
UPDATED 6/25109
OWNER INFORMATION
NAME: c\ n`c !� C�' k �p ginieta IIG
ADDRESS: fool
CITY: cTe NNSyl �K "l STATE: { �� ZIP: 1 �1�
PHONE (DAYTIME): Email: 0�A� ( c-kc-m r_ifj an 0D CC1M CM 3 • Ae
IF THE FEE SROPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SEMPLE TITLEHOLDER: LV f A
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (__
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: ST. LUCIE COUNTY CERT 0:
BUSINESS NAME:
QUALIFIERS NAME: d
ADDRESS: .6t OL o )v
CITY: 6iUCX(_ STATE: �L rr ZIP:
PHONE (DAYTIME): 02 2_C �63 FAX NO. Z7Z - � b Email: �1i &Ct�� S1fuL'� Dn f�
. Ca�CrAS�• �@.fi'
ARCHIT/ENGR, EER: l - }i- J 1 uu
ADDRESS:`` I) 2l cz OceUn
CITY: STATE: r7, ZIP:
PHONE (DAYTIME): 0% Z I JT' " i�% bO
W
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
ZIP:
ZIP:
DIPORTANT 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 avail.
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 cer-tify 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 RVIPROVEMENTS 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.
O . R aORCONiiO�C_TOR SIGNATURE
STATE OF FLORID
COUNTY OF����
The foregoing instrument was acknowledged before
me this J day of 20
by ���u� �•'�N`�ee�i0.
who is personally known ✓ or has produced
Signature of Notary
Commission No. Z4 Fsr1g4Qa
u
was identification.
•V�Jne6'204�A:
• m!
2p 9EE 879982 �Q_z
j� '�k L. y
CONTRACTOR SIGNATURE
STATE OF FLORID
t\
COUNTY OF A�
The foregoing instrument was acknowledged before
me this S day of A u%U� , 20
by Q .
who is personally known V or has produced
Signa€rrre of Notary
Commission No. Er.
as identification.
>i,gETH[,�'rii
:(S 4 Jae 6,
• m:
o : YEE879982 : Q
NOTE: TWO (2) SIGNATURES AB 'CH SIGNATURE MUST BE NOTARIZED.
THIS BUILDING PERMIT ASUILDER, THE OWNER MUST PERSONALLY
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. 1r1N,of;:
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.