HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT,bZiRREN
DATE FILED: (�
- ; PLAN REVIEW FEE: RECEIPT NO_: PERMIT NUMBER: �
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SECTION TOWNSHIP RANGE MAP NO. /„ / CONCURRENCY FEE: RECEIPT NO.: ' CERT. CAP. NO.:
TAZ NO. ZONING LAND USE LOT CV G °7° ALL lNF S BE COMPLETE & FILLED IN TO BE ACCEPTED
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sz t."Lucie County Building,4nd.Zonin.g.
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FLOOD ZONE FIRM MAP # 1 -FLR ELV MAX HGT � :. ..: 1n - '
230D Virginia Avenue
[{3F{lOp` I Ft. Pierce, A. 34982-5652
CONST TYPE ? OCCUP TYPE MAX OCCUP # OF FLRS ; ; 772462-1553
WATER SEWER SPRINKLERS STORMWATER St RWUcATION for BUILDING PERMIT
! CERTIFICATE of CAPACITY/ZONING COMPLIANCE
LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT
fore 1/90) '1190 REQUIRED APPROVED
_ PROJECT INFORMATION
i
/SI DRES isf
LOCATION TE AD S: L�q t; 5 a 9 ClwJ . rNl vJ A Y (t P 1
ADMINST ' LIBRARY PARKS PERMIT
VARIANCE IMPACT FEE IMPACT FEE FEE 2. S/D NAME: SITE PLAN NAME:
REPORT" ' ' PUBLIC BID / HABITABLE RADON FEE 3. PROPERTY TAX ID #: 3. O0 - 4 Z 1- o O c i - 0.o0-2
CODE. IMPACTFEyw AREA - 4. LEGAL DESCRIPTION (attach extra sheets if necessary) 5 3 (o 40 E Ot= 4C- I 6,F
N tnl l��i
RADON)
Of LE55 tM iDWAY Rb
r GROSS ROAD CREDIT Y N - TOTAL ROAD ! 5. FLAT 6: PAGE' ' ` � 7. BLOCK
FEE IMPACT FEE IlII' = S. LOT
IMP CT PACT FEE BOOK NO. NO. NO.
E - '
SCHOOL CREDIT Y N TOTAL 9. PARCEL SIZE: ACRES/SQ FT.. L4. It °l LOT DIMENSIONS n
IMPACT FEE SCHOOL !
IMPACT FEE
P ICE FEE FIRE FEE __ _ _ -� _ _ _ _ _ MISC FEE TOTAL
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: N C-W OF F i C G
A%�� (��j� POLICE/FIRE
_ `MISC FEES
ADDITIONAL Y. N SPECIFY TOTAL • l 1. SETBACK
PERMITS S (ACTUAL) FRONT: BACK: RIGHT: / LEFT:
.' of ALL = / o
REQUIRED FEES
6 a SIDE .. �D SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
- ! [ NEW CONSTRUCTION [ ] EXPANSION/ADDITION ` "EVIE
INTERIOR RENOVATION
REVIEWS ZONINGPLANS MISC. VEGETATION SEA TURTLE MANGROVE [ ] RESIDENTIAL COMMERCIAL [ j INDUSTRIAL
EXAMING [ ] OTHER (SPECIFY)
DATE 13. DESCRIPTION OF PROPOSED USE:
COMPLETE
INITIALS
14. -Sq. FtJCONSTRUCTION: ' r `7 15. Sq. Ft. I st Floor:
16. VALUE OF 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
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.
Wn
SLCCDV Form No.: 001-02 feu
CERTIFICATION:
OWNER -INFORMATION
NAME: LPN t L- -4- 'ROY DR. A W D Y = i
ADDRESS: 2aJ y S W. - t DvJAy. R D.
CITY: 1'T . PI EK.G e STATE: F'� . . - ZIP
PHONE (DAYTIME): 772-`-Ito 4- 81 Lob 'email: �e t-f e dra�dyb�o}1Ltts. caws
IF THE FEE SIMPLE TiTLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: '%J A
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME):
CONTRACTOR tNFORMATION .
ST. of FL REGJCERT #: C G GA , 13 —19 -1 ST. LUCIE COUNTY CERT # O �"
BUSINESS NAME: ^DA 6 Lt DY {3r_61- {t_ e s CON s'[e LL C-TLyJ
QUALIFIERS NAME: '�B,bY Tk A W 01
ADDRESS: 2* y -5 M0 W AV R p .
_ Pl fet e-ti STATE- r ZIP 3 y C1 f I
CITY: �, �- .
PHONE (DAYTIME): - (77y, LI Q L14 I LK) FAX N0. -M-- 41' 4 --0 3" email: - - — - - -
ARCHFT/ENGINEER:-GVE LICAI&51 -
ADDRESS: 10 -7 10 5 W W CST LA; n1,t) g L-J D
CITY: STATE: F - ZIP
PHONE (DAYTIME): 7 2-i $ 5 • (s 4 (o 6-
BONDING. COMPANY: N 1 A
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER: N ) A
ADDRESS:
CITY: STATE: ZIP
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 ctaVs after notification
it will be voided and returned to you by mail.
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 YOURNOTICE 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 compliance
'th all applicable laws regulating construction and zoning.
O R/CONTRACTOR S NATURE CONT OR SIGNATURE
STATE OF FLORIDA STATE OF FLORIDA
- —_ COUNTY OF - _ L CC 1 G COUNTY OF 'ST. L,"c I C
The foregoirig.iiistrument was acknowledged The foregoing instrument was acknowledged
before me this. 31 day of ' MA I, 2(b;., by before me this ✓ 1 day of MAY , 20r7 by
I�tl� �Teay D2g„ ,who is e o 'TA olr IDR,*WO - , who is personally
known to me or who has pioduced known to me or who has produced^
as identification. as identification.
SigbWtj9of14otajry Signs a of po NotaryPublic State of Florida
=o e
Syr a Notary Public State of Florida Jennifer Pottoon
r Jennifer Pottorff 9A Commission DD445478
Type or Print Name of Notary Type or Prin N Nof s 0911012009
y1y tvty commission DD445478 YP _
• OF Expires 0911012009 -
Commission No... (Seal Commission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. 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.