HomeMy WebLinkAbout0506-1220 APPLICATION FOR BUILDING PERMITBP #: =Ic—, QQ 0
OFFtC� :USE QI�L
SECTION:
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLR E
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (bet 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
L07 SPLIT
REQ'D
.,,AfDPR\rD
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLDG
HABITAB
RADON FEE
CODE
IMPACT FEE
AREA
(' )
N
oo,
-Y
N
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
YN
.......
SCHOOL
CREDIT
......
TOTAL
IMPACT FEE
...
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
TOTAL ALL
PERMITS
FEES
_PECIFY:
REQ'D
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
OVA
COMPLETE
INITIAL
011
SCANNFD
OffjqgQ By App
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCYFEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE er FILLED IN TO BE. ACCEPTED
DEG
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT 1601
2300 VIRGINIA AVENUE le
FORT PIERCE, FL 34982-5652
561-462-1553 fna loads -
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1.
LOCATION/SITE ADDRESS: 3.3002eAnrRPRzsC-&Ah
2.
S/D NAME: SITE PLAN NAME:
3.
14
PROPERTY TAX ID #: ;z9 - oqoolo
4.
LEGAL DESCRIPTION (attach extra sheets if necessary): SZO
ea-r 3z-(3-03A4,)
5.
PLAT 6. PAGE 7. BLOCK
8. LOT
BOOK NO. NO.
NO.
9.
PARCEL SIZE: ACRES/SQ FT. -7-03 z4e— LOT DIMENSIONS
10.
DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: sari
66
Il.
SETBACKS (ACTUAL) FRONT: BACK: RIGHT
LEFT
SIDE
1p* SIDE:
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION EXPANSION/ADDITION
INTERIOR RENOVATION
j I RESIDENTIAL C?MMERCIAL
INDUSTRIAL
OTHER (SPECIFY) MAI
13.
DESCRIPTION OF PROPOSED USE: C 06A M &I e ft-A L Sy"lAY—g —A)(/
14.
Sq. Ft./CONSTRUCTION: 15. Sq. Ft. I st Floor:
16.
VALUE OF CONSTRUCTION: $ r,060
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 advitles. If the value is $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
J,
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME: _m acuo JS 6) / `59ft Q T' /A)G,
ADDRESS: / 3 kA GA) Tti MSC /&AA0
CITY: v �����r STATE: ZIP
PHONE (DAYTIME): ('I'JZ1 /- -W3 -,?,-
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): ( I
CONTRACTOR INFORMATION
ST. of FL REG./CERT #:
STATE:
ST. LUCIE COUNTY CERT #:
ZIP
� Jr
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.
COUNTY OF COUNTY OFF
ARCHIT/ENGINEER:
The foregoing instrument yva��s�n acknowled
ADDRESS: tsp"rod�acbed
e this , day of �� K , 20�, byg2old
CITY: STATE: ZIP who is er onally known to me or who
as identification.
PHONE (DAYTIME): 1 l - . - - "
fgna re of otary
BONDING COMPANY: ` r.
ADDRESS: Type or Print Name of Notary
CITY: STATE: ZIP Notary Public Title
MORTGAGE LENDER:
ADDRESS:
CITY: STATE:
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.
a
The foregoing instrument was acknowledged
befor me this . day of l l , 2006 , by
who is personally known to me
r who s d d as identification.
Signature of qotary
Type of Print Name of Notary
Notary Public Title
_b aCommission Number 17DM'9q;) Commission Number
�.w PN Aiyssa F Poole
(seal) My Commission DD177842 (seal)
pia f,o Expires Apri114, 2007 ip�W" "k AlYssa F Poole
e` My Commission DD177842
or le Expires April 14, 2007
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.