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HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITSECTION.- ( I TOWNSHIP RANGE I I MAP NO. .ZONING LAND USE LOT CV G % TAZ NO. FLOOD ZONE FIRM MAP # I FLR ELV MAX HGT ' ' CONST TYPE J'OCCUPTYP`E MAX OCCUP # OF FLRS WATER SEWER' SPRINKLERS STORMWATER LOT OF REC (before 1/90) LOT OF REC (after 11/90'), •. LOT SPLIT REQUIRED LOT SPLIT APPROVED , • VARIANCE 1 ' ' �• REPORTPUBLIC DLD. �• CODE �IMPACTFEE e• IMPACTFEE IMPACT FEE DUE ,SCH• • •'SaF.�. r' 5 t. e• gy x �tri;` 5 z k�.�IMPACT FEE •• • 'MIS D • ®®TOTAL PERMITS ofALL REQUIRED FEES ..!"-.?' n'Lf f �'.-n.T_>- �{ v1J :T• ,U }� T t yl �Xi�L��,2..J r..�.�c.. s°• as` ., sSi..�.�,"i..,. , �5.... , —. - �,',�:ir.�' lY. RNA_ l_. ,r••a_ - _�---.5',. ta....._...._••��Sz s»a.� ?c_�. -:..:.-_br_.r :ham ' t• • tZONING• • REVIEWEDBY DATE INITIALS PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: CONCURRENCY FEE: RECEIPT NO_: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St. -Lucie County Building and Zoning, f SCANNED 2300 Virginia Avenue .'�!{3R1ljP BY Ft. Pierce, FU 34982-5652 z •772-462-1553 at Lucie County ®unty APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION I . LOCATION/SITE ADDRESS: 2. S/D NAME: SITE PLAN NAME: 3- PROPERTY TAX ID #: - �� �• /3 •©�- 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT 6. PAGE 7. BLOCK 8_ LOT BOOK NO. NO. NO. 9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS 10. �� DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: c;�f)f 140 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT: SIDE SIDE 12. n- TYPE OF CONSTRUCTION (Check all appropriate boxes) V NEW CONSTRUCTION [ ] EXPANSION/ADDI_TION [ ] INTERIORRENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. e0 DESCRIPTION OF PROPOSED USE: �I 14. , Sq. FtJCONSTRUCTION: 15. Sq. Ft. 1st Floor: 16. VALUE OF CONSTRUCTION: S 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 CERTIFICATION: r OWNER -INF : Ramp NAME: ADDRESS: .CITY: , 1P1 C- e'•e- TION PHONE (DAYTIME):Y �OO � 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: CITY: PHONE (DAYTIME): �) CONTRACTOR INFORMATION ST. of FL REGJCERT ##: BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: STATE: ZIP STATE: YTIME): ( _)-- - '--- FAXNO. ARCHIT/ENGINEER: ADDRESS: CITY: STATE: PHONE (DAYTIME): �) BONDING. COMPANY: ADDRESS: . CITY: STATE: MORTGAGE LENDER: ADDRESS: CITY: STATE: ST. LUCIE COUNTY CERT #: ZIP email: ZIP ZIP F 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. 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. 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. SIGNATURE STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged•. before me this day ofTeE� 20Q6 by '��� •'' _:R ( 0,1Q U 11l bh who is personally o to me who has produced a o 0 as identification. a 2 zoo=. PCO Signature of No m Type or Print 11ame of Notary CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF The foregoing instrument was -acknowledged before me this _ day of , 20_, by who is personally known to me or who has produced as identification. Signature of Notary Type or Print Name of Notary 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.