HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE USE ONLY BY #'
SECTION I I TOWNSHIP
ZONING ��_4 LAND USE
FLOOD ZONE \A/ FIRM MAP #
CONST TYPE I I OCCUP TYPE
WATER 11 —):-
,) I I SEWER
LOT OF REC I I LOT OF REC
Before 111990 After 1/1990
REPORT (HABITABLE
CODEAREA
1/0/
io n r� 11
IMPACT. IMPACT FEE
FEE CORRECTION
RANGE I I MAP NO.
LOT CVG % �.� b�-� TAZ NO.
1
I ST FLR ELV MAX HGT
MAX OCCUP I I # OF FLRS
SPRINKLERS I I STORMWATER
LOT SPLIT I I LOT SPLIT
REQUIRED APPROVED
RADON I I PERMIT
FEE FEE
GENERAL
CREDIT'
IMPACT
FEE
SCHOOL ROAD Y N LAW ENF
IMPACT CT
FEE FEE
FIREIEMS DRIVEWAY Y N
IMPACT REQUIRED
FEE
SPECIFY_ MECHANIC ROOF NON -CONFORMING
SUBS ELECTRIC - GAS , LOT OF RECORD
REQUIRED . PLUMBINC _ f� I S
DATE SENT TO ADDRESSING:
REVIEWS FRONT ZONING'
COUNTER REVIEW
161910 /W&
DRIVEWAY
FEE
IMPACT
FEE
ADMINISTRATIVE
.VARIANCE FEE
MISCELLANEOUS
FEES
SUPERVISOR PLANS VEGETATION , SEA TURTLE
REVIEW REVIEW REVIEW REVIEW
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lb-3�
1
1
SCANNED
MANGROVE
REVIEW
t p
OFFICE tJSEO"FEE:
/%• � �
DATE FILED: q<j(F�fS PERMIT NUMBER:
PLAN REVIEW • b RECEIPT NO.: CERT. CAP. NO.:
CONCURRENCY FEE: � RECEIPT NO.:
ALL INFO MUST BE COMPLETE & FILLED INTO BE ACCEPTED
ENT SERVICES DEPARTMENT
,E REGULATIONS DIVISION
Jirginia Avenue
;e, FL 34982-5652
>,462-1553
G
DING PERMIT
)NING COMPLIANCE
PROJECT INFORMATION
LOCATIONISITE ADDRESS:
PROJECT NAME: ?N+S SITE PLAN NANIE:
PROPERTY TAX ID #: ®� � « ' 0117 � •' � OO _ (0 p r
- l
PLAT BOOK 6. PAGE NO. 7. BLOCK NO. t 05 8. LOT NO. ZS
PARCEL SIZE (ACRESISQ FT.): ®E 2_% LOTDIMENSIONS: Q s K ] �-S
COMPLETE DESCRIlTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
�C�-+lam � � �-$d
SETBACKS (ACTUAL) FRONT: 2 U f RIGHT SIDE�4-% LEFTSIDE .
TYPE OF CONSTRUCTION (Check all appropri
[d NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL j ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) '
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR:
VALUE
OF CONSTRUCTION: S l \ Z_ j, S ® 0
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
i
OWNER INFORMATION
NAME: SA- V�CG Ce_ C-0 (z)03+ i
ADDRESS: L� 3 Q -� 5-�-
CITY: 1�0)y-F CP r`G' C �- STATE: Z1P:
PHONE (DAYTIIviE): Z)` o Z- ( � 3 Email: K� U �� e5`4` �. G C e_Q .6
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)
W_ l K_
`) It, STATE:
CONTRACTOR INFORMATION
ZIP:
ST. of FL REG.CERT #: r <.SC— «k. 5 4 Cl -5 ST. LUCIE COUNTY CERT #: J T
BUSINESS NAME: QUe COVra Rc c-6"(5o 9c_zU e CC S
QUALIFIERS NAME: H NO VX L O
ADDRESS: 3 'J1 3"t S 0 &0 �- � �
STATE: FG- ZIP: 3
PHONE {llAYTIl1IE):-(, Z) 1S - 2 `E `F � FAX NO.C� �i z) 33 & - q 3 }q Email:
ARCHIT/ENGINEER: VN0 l \0e_� G\& klJ —
ADDRESS: VR B A 5-
CITY: STATE: F l� ZIP: �q
PHONE (DAYT`IME): } $ B
BONDING COMPANY.
olk
ADDRESS: N 1 K-
CITY: W I R
MORTGAGE LENDER: 1(�
ADDRESS:
CITY
STATE: ZIP:
V� STATE: W l 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 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 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 ROPROVEMENTS 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 YOURRIGHT, 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.
�a ti
OWNER OR CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLORID _ STATE OF FLOPIPA_ ' k\
The foregoing instrument was acknowledged before
me this A day of 20 l_--�,
by��x
wh 's personally known or has produced
t�
.. ..A
Signature of N to :'':4j:! �- Pi;;E ts'. %!FF
0A3530
Commission No. is
The foregoing instrument was acknowledged before
me this i-__
day of 2.0�
`
la
by ` l' nnn -
who is p �somlly known or has produced
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.