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Home My WebLink AboutAPPLICATION FOR BUILDING PERMIT0,:, 6 N"I 'dfif SE LY, SECTION TOWNSHIP 444 RANGE MAP NO. 141-36 s, ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # r IST FLR ELV MAX HGT CONSTTYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATE LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT (before 1/90) 1/90) REQUIRED APPROVED ADMINST LIBRARY PARKS PERMIT VARIANCE IMPACTFEE IMPACTFEE FEE REPORT CODE PUBLIC BLD IMPACTFEE 996. VI el _H_A_B_1_T_A_BTE— AREA _RADONTEE— 30.00 (RADON) GROSS ROAD IMPACTFEE (6- NO. oa CREDIT Y TOTAL ROAD IMPACTFEE 6 ffba, &6 SCHOOL CREDIT Y N TOTAL IMPACT FEE SCHOOL IMPACT FEE - POLICE FEE FIRE FEE MISC FEE TOTAL POLICENIRE MISC FEES ADDITIONAL N SPECIFY ;r/Z&T9_i C-A I TOTAL PERMITS ofALL REQUIRED FEES -77-7777-777-7,�� i'.j REVIEWS ZONING ZONING PLANS misc. VEGETATION SEA TURTLE MANGROVE REVIEWED BY EXAMING DATE COMPLETE LINITIA LS N.; OFFICE USE ONLY-# DATE FILED: PLAN REVIEW FEE- 0 � 0 0 RECEIPT NO.: PERNUT NUMBER: CONCURRENCY FEE: /_jX n -D RECEIPT NO.: CERT. CAP. NO.: ALL INF MUST BE COMPLETE & FILLED IN TO BE ACCEPT']fD -ro -?r_-Crn �T rtpe 100 St. Lucie County Building and Zonim 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 *0-eed Si5oL1-ed_,(M&PtJ 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE 31 q0 PROJECT INFORMATION (--+- PC tr-N -ri-13�0--; V% 4;.. Ij LOCATION/SITE ADDRESS: 4!r- 3 2. S/D NAME: SITE PLAN NAME: 3. PROPERTY TAX ID 0 Rc) 114 f 4. LEGAL DE a actf-e-xtra-sheeftif-necessary-)- e-e- 5.. P LAT 6. PAGE 7. BLOCK 8. LOT BOOK NO. NO. NO. 9.1 PARCEL SIZE: ACRES/SQ FT. LOTDIMENSIONS C%LV- e_s 10.1 DESCRIPTION OF COT�STRUCTION PROJECT OR WORK ACTIVITY: �k n!q 6Y, 11.1 SETBACKS (ACTUAL) FRONT BACK- RIGHT LEFT: Q �,. k Lf emv 7)—,-7 -12.' TYPE OF. CONSTRUCTION (Check all appropriate boxes) �NEW CONSTRUCTION EXPANSIONIADDITION INTERIOR, RENOVATION r 31 RESIDENTIAL. COMNIERCI'AL INDUSTRIAL. j 3 OTFIER (SPECIFY) SE:' DESCRIPTION OF PROPOSED U IL 06% Sq. F I t./CONSTRUCTION: 15. Sq.-ft Ist Floor: '16. VALUE OF CONSTRUCTION: $ a C The value of construction is used to determine the amount of permit fees to be assessed; St. Lu . cie County reserves the right to question and/or modify the indicated value of construction if it is demonstrated that the nstruction activities.'. If the value is $2500 or more, a submitted. figures are not consistent With similar types of 66 RECORDED Nofice-o'iCo'nimencem- en't must be.subm'itted with this application. SLCCDV Form No.: 00142 1 7 OWNER INFORMATION tic i-6,a CA" NAME: ADDRESS: 2C0??__ CITY: +c�, STATE: ZIP 3!f94 (a PHONE (DAYTUvfE): Aci - 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: S+. ADDRESS: * � � . A - CITY: % V_ ir CAL STATE: zip 34cl �'L PHONE (DAYTIME): 13� 4 6 Z_ —11 'It, 0 1 - CONTRACTOR INFORMATION q.9 r7 ST. of FL REG./CERT #: C13C 0143ca ST. LUCIE COUNTY CERT 4, BUSINESS NAME: S: L c-j-- QUALIFIERS NAME: ADDRESS: ffcvc> V CITY: - ( ) Q r STATE: zip. *3 L1 Ci Y 7- PHONE (DAYTIME),. FAXNO.-77);�'--,C)P?�--f'Wemail: ARCHIT/ENGINEER: ADDRESS: CITY: STATE: ZIP Cl 00 PHONE (DAYTIME)_*M!b__i2�!__C_14 (114 BONDING COMPANY: ADDRESS: CITY: STATE: ZIP MORTGAGELENDER: C-0 (k,66 13 c- n ADDRESS: 6%o CITY: STATE: ZIP 1_0 IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notif,10'atidn it will be voided and returned to you by mail. 7.'i 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: roo 'in 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 TFUS 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 compliance with all applicable laws regulating construction and zoning. OWNER/CONTRACTOR SIGNATURE 0 TRACTO)CSI I�ATURE < CO T ffl= STA TE OF FLORIDA , COUNTYOF_,5,k /U0,'0 Th6 foregoing instrument was acknowledged b fig me this ay of #%&&20�7 by who is personally nowr oduce_j� as identification. 'of Notary STATE OF FL,� AL OF � ,J COUNTY The foregoing instrument was acknowledged beforemethis,a dayofrqn 20Q by 13an, 11, 4. Mo re,' 5 , who is personally known' to me or who has produced �� 4- asidentificatioi N /J/ 5004filiv type 0 r r I H_,',,,`77WL6U1SE- CALDWELE Pubil fa of Florida Notary Puiblic - St -teAf Flo ricla mm 9s Co 7,2007 n-7.'2008 Commission # DD256155 COMmIssion # DD 270723'*'. 7Z -11orial NotaiyMn. /)6179 3 R, B o n d e d R v m rided National Nota Assn. IRED. EACH SIGNATUI IF ITF 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.