HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE USE ONLY BP #: 070 QQ *-7
SECTION
TOWNSHIP
RANGE
MAP NO.
143d S
ZONING
LAND USE
—1,
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
176
IIT FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
1
SPRINKLERS
.7
—7TORMWATER
S
LOT OF REC
(b e fore 1/90)
LOT OF REC (aftet
1/90)
LOT SPLIT
R EQUIRED
LOT SPLIT
APPROVED
ADMINST LIBRARY I PARKS PERMIT
VARIANCE IMPACTFEE IMPACTFEE FEE
REPORT
CODE
3AO
PUBLIC BLD
IMPACTFEE ;S%
0
99.0 HABITABLE
' I w AREA
(RADON)
RADON FEE
jq?
J, Rrz
IMPACT F=
MAf Id
GROSS ROAD
IMPACTFEE
DUE
&0
CREDIT
Y
N
TOTAL ROAD
IMPACTFEE
00
SCHOOL
IMPACTFEE
CREDIT
Y
N
TOTAL
SCHOOL
IMPACTFEE
POLICE FEE
FfrE MISC FEE TOTAL
—POLICE-/FfRE—
MISC FEES
N SPECIFY TOTAL
ofALL
FEES
ADDITIONAL
PERMITS
REQUIRED
(Kh
REVIEWS
ZONING
ZONING
REVIEWED BY
PLANS
EXAMING
misc.
VEGETATION
SEA TURTLE
MANGROVE
DATE
COMPLETE I
MS\10
I
q-9-02
I i
1
V4" 1
X�o _ 0117
_AA
DATE FILED -
PLAN REVIEW FEE: RECEIPT NO.:
PEA% NUNMER:
'Y
CONCURRENCY FEE: RECEIPT NO.: NO.: A I
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County Building and Zoning
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
z I YO Ri (Mc�rl6br PROJECT INFORMATION
1. .-LOCATION/SITEADDRESs. 5t_V4ce.-At,
2. S/D NAME: SITEPLANNAME:
3. PROPERTY TAX ID 0 C)o t —
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT 6.'PAGE 7.* BLOCK 8. LOT
BOOK.. NO. NO. NO.
A
9. PARCEL SIZE: ACRES/SQ FT. LOT DffvfENSIONS
CAGV_ C—IS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
nq
—LEF
11. , SETBACKS (ACTUAL) FRONT BACK: ;j F IGHT- T.
ctlo-k SIDE 31 S' SIDE
12. TYPE OF,CONSTRUCTION (Check all appropriate boxes)
)NEW CONSTRUCTION EXPANSION/ADDITION -INTERIOR RENOVATION.
r 31 RESIDENTIAL COMNIERCIAL
OTBER(SPECIFY) INDUSTRIA�
DESCRIPTION OF PROPOSED USE:
14. Sq.Ft./CONSTRUCTION 15. Sq. Ft. I st Floor: ILL Ct 0
o
ILI,
16. VALUE QF-CONSTRUCTION: $
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
valife 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
R9C6R'DED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
'13 c- V_ <:t'�Ne tze- () -4",- si
NAME: % -,s , J
ADDRESS: 2 cl �? ?__ <_ j -i- k -% R K- � v% t� 'T� - 'J k e J
CITY: :;Pl> STATE: ZIP 3494(a
PHONE (DAYTIME): email:
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:
A V
CITY: STATE: PL_ ZIP 34ci �-L
PHONE (DAYTIME):
CONTRACTOR INFORMATION al
C
ST. of FL REG./CERT #: C 03 4 ST-LUCIE COUNTY CERT
BUSINESS NAME: L oz
QUALIFIERS NAME: Is 6�'f- 1Ir M tz' %rv- �� $' -
ADDRESS: 90K> V'i n %3
CITY: C'e STATE: ZIP
PHONE (DAYTIME): FAX NO. -77,;)- -W- I 115'email:
AIN't—ril I =NWINVILK: VN T-- OZ.
ADDRESS:
jAW
CITY: P';e O-C-k STATE:,
PHONE (DAYTIME)-qd2h3
ao-'A4 Qf
ZIP
BON DING COMP ANY:
ADDRESS:
CITY: STATE: zip
3 LIC, Y
f3M--Pr'%Seg,oL.
JJJ12 1
2'4q Y -C
MORTGAGE LENDER:
ADDRESS: 6to
CITY: STATE: IF L— zip�
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 d
kys 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, 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 SUB)ECT
TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
OWNER/CONTRACTOR SIGNATURE �'��CTOI�,�IG14ATURE
STATE OF FI
1COUNTY OF
STATE OF
The foregoing instrument was acknowledged The foregoing lnfgument was acknowledged
41hay of avl� y
before me this _U 20D'7 b before me t�is — day of 20L7, by
-+-114 4EI15 , who is personally
AfIv 6
knQown �to me �o_ho has produced known t6 me or who has produced FD 4-
as identification. Ig 02C3=Q -QQ K-oas identification.
Signature of Notary &tyofll t
Signa ure
I y-
LL
frype-o me NMt -CA
Type or Print Name of Notary ISE LL
....
D BORAH L. BLAIR Notary Putllic'- State of Florida
E
8
Comm# DD0267382
: - - - Comm
Commission No 1 -7. eal Com KsionMV7,2008
MIS 9
Ej(pirss loliq2007 C—RFnffl 9723
Jr
to
1 0,1 thru (800)4�2-4254-
p. B.1d OF F ry ss
I . "I, ..... . Bonded By National NotaryAsin.
r-ioe I 'J
ida Not0rY=.;.i
NOTE: TWO (2) SIGNATURES ARERE�QMXEIT EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING. F" OR
THIS BUILING PERMIT AS AN OWNERIBUILDER, -THE OWNER MUSTTERSONALLY APPEAR TO S . IGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions se . e appropriate permit checklist.