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Home My WebLink AboutApplication For Permit ApplicationrfA?Jof \ I OFFICE USE ONLY gpp OFFICE USE ONLY SP #: O SECTION bs d� TOWNSHIP �. RANGE 4oE MAP NO. `•� ZONING � � LAND USE Ru LOT CVG % '� np �.3 se.gs 1� TAZ NO. FLOOD ZONE FIRM MAP # lsr FLR ELV MAX HGT CONST' TYPE OCCUP TYPE �� MAX OCCUP # OF FLRS WA"IER erect SEWER � �(� SPRINKLERS STORMWATER LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT (before 1/90 1/90 RE UIRED APPROVED ADMINST VARIANCE LIBRARY � �•� 18 PARKS 4E� � PERMIT IMPACT FEE f° IMPACT FEE FEE REPORT 1�1 PUBLIC BLD iIf �� `t� al'+s HABITABLE ,�F r 11 .95 n� �r 4gq6 , �,. �,1 a11�� V ` RADON FEE CODE IMPACT FEE �� AREA • RADON C7 _ GROSS.ROAD _ CREDIT Y N - TOTAL ROAD IMPACT FEE y IMPACT FEE IMPACT FEE 1 DUE SCHOOL � � CREDIT Y N TOTAL IMPACTFEE � � SCHOOL IMPACT FEE P CE FEE FIRE FEE �I C , _� MISC FEE V`w� TOTAL POLICE/FIRE w•�.� 1 MISC FEES AllDITIONAL Y N SPECIFY TOTAL PERMITS of ALL REQUIRED V M_ FEES REVIEWS ZONING ZONING PLANS MISC. VEGETATION SEA TURTLE MANGROVE REVIEWED BY EXAMING DATE n COMPLETE I INITIALS OFFICE USE ONLY: DATE FILED: i PLAN REVIEW FEE: RECEIPT NO.: 0 1505 PERMIT NUMBER: COO — CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE &FILLED IN TO BE ACCEPTED St. Lucie County Building and Zoning ' 2300 Virginia Avenue ' ORS Ft. Pierce, FL 349$2-5652 772-462-1553 PPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJQECT INFORMATION � � 1. LOCATION/SITE ADDRESS: 'yS(=► l.So ' CA T I\e <( 2. S/D NAME: _I.1 e 1 Q liV SITE PLAN NAME: 3. PROPERTY TAX ID #:- 4. LEGAL DESCRIPTION (attache tra sheets if necessary): �' ' VII ^^ii %/ 1 vJ 210 {'' CJ1 5. PLAT 6. PAGE 7. BLOCK 8. LOT BOOK�J NO. NO. � NO. 9. PARCEL SIZE: ACRES/SQ FT. / 7DS LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PRO'�'1y�''/`-q�.■ TOR WOrK ACTIVITY: "Oo, 11. SETBACKS (ACTUAL) FRONT: -DSJ,�OBACK: `s.Cl � SIDE RIGHT: � ` •�� SIDE. 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: � ' L • t 14. Sq. Ft./CONSTRUCTION: ,S 15. Sq. Ft. 1st Floor: � q IK� 16. VALUE OF CONSTRUCTION: $ I qja � 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 $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 J OWNER INFORMATION C� NAME: `1A1t111 ;Z vvi c�i/1r4 __�=30P_k ADDRESS:QC--�t��rY�py- CITY: �e STATE: zip PHONE (DAYTIME): QQ) y'fj$ - �j� �o email: —\-: >jPij�'Fo ne_7� 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: PHONE (DAYTIME): STATE: ZIP CONTRACTOR INFORMATION 1 ST. of FL REG./CERT #: �[J ST. LUCIE COUNTY CERT #: C } BUSINESS NAME: —Y QUALIFIERS NAME: ADDRESS: CITY: STATE: �ZIP q S PHONE (DAYTIME): Ala 4 - FAX NO.gtey ?�a email: ARCHIT/ENGINEER: A� 4 LI- 1 e�PSC�Q rp [, 6 h n 45 4 ADDRESS: CITY: STATE: -F ZIP PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: 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. 'N') 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, 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 be done in comp] with all applicable laws regulating construction and zonin OWNER/CONTRACTOR SIGNA RE TRAC R SIGN T RE STATE OF FLORIDA STATE F FLORID COUNTY OF COUNTY COUNTY OF The foregoing instrument was acknowledged before me this,251ay of , 2005by r who is personally known to me7 or who has produced--------:— Commission No. The foregoing ins ent was ac owle�dged before me thi day of , 2p[l� by who is personally known to me or w;io has produced T" HOLLY E. SAMMONS ypp or Print Narrie of Notary MY COMMISSION # DD42676 ission NoDbqx�y&:zSeal} EXPIRES: May 8, 2009 C6 C)fW 2 NOTE: TWO (2) SIGNATURES A EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILING 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.