The URL can be used to link to this page

Home My WebLink About0707-0159 APPLICATION PERMITOFFICE USE TgL�Y / J :OFFICEONLY g A . ([ ( n a ' ' . P #: O = O ; I PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: D 15 1 I CO NCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: SECTION TOWNSHIP RANGE � MAP N0. ALL INFO MUST BE COMPLETE & FILLED IN, E ACCEP_TED�= ZONING I LAND USE LOT CVG % TAZ NO. J 6 CO f �— A', �d . � � St. Lucie County Building and Zo '' g � , J� Ill FLOOD ZONE FIRM MAP # I sT FLR ELV MAX HGT �` � U r ��pp 2300 Virginia Avenue / N ED Ft. Pierce, FL 34982-5652 ��aa 772-462-1553 CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS si tude count1/ APPLICATION for BUILDING r PE a WATER SEWER SPRINKLERS STORMWATER CERTIFICATE y ° � of CAPACITY/ZONOMPLIANCE LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT PROJECT INFORMATION before 1/90 1/90 REQUIRED APPROVED 1. LOCATION/SI ADDRESS: ADMINST LIBRARY PARKS PERMIT 2• S/D NAME fi \ � i ra Et— SITE PLAN NAME: _ VARIANCE IMPACT FEE IMPACT FEE FEE 3. PROPERTY TAX ID #: ` mil, ��f j�/""��p®n �a� �� ✓ REPORT PUBLIC BLD-TABIT'ABLE— _RADON_FEE_ 4• LEGAL DESCRIPTION (attach extra sheets if necessary): T{� �? CODE �O IMPACT FEE AREA - (RADON) I 5. PLAT 6. PAGE 7. BLOCK : LOT SCHOOL GROSS ROAD CREDI Y N TOTAL ROAD BOOK NO. NO. NO. IMPACT FEE IMPACT FEE IMPACT FEE i DUE 9. PARCEL SIZE: ACRES/SQ FT.NA LOT DIMENSIONS SCHOOL CREDIT Y N TOTAL IMPACTFEE f SCHOOL 4. V • r IMPACT FEE 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: POLICE FEE FIRE F MISC FEE TOTAL i POLICE/FIRE / MISC FEES 11. SETBACKS (ACTUAL) FRONT: A, BACK: RIGHT: LEFT: ADDITIONAL N SPECIFY TOTAL SIDE SIDE PERMITS of ALL REQUIRED FEES 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) .. CTI EXPANSION/ADDITION ] INTERIOR RENOVATION ' [ ] INDUSTRIAL NEW CONSTRU ON ` [ ] E [ [,m OTHER (RESIDENTIAL SP C FY) REVIEWS ZONING ZONING PLANS MISC. VEGETATION SEA TURTLE MANGROVE REVIEWED BY EXAMING 13. DESCRIPTION OF PROPOSED USE: �- DATE ` VL2, 7—/ /_V ICOMPLETEf� Oy / 14. Sq. Ft./CONSTRUCTION: [A 15. Sq. Ft. 1st Floor: N INITIALS 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. Ifthe value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 CERTIFICATION OWNER INFORMATION CITY -6/�f Vl, � �% if��/��L / STATE: /�- ZIP S 6�� _ PHONE(DAYTINIE): il: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SHVIPLE TITLEHOLDER: %9 ADDRESS: CITY: PHONE (DAYTIME): (_� CONTRACTOR INFORMATION ST. of FL REG./CERT BUSINESS NAME:2- QUALIFIERS NAME: ADDRESS: CITY: ,4 � A STATE: 01� ---b- -i. . F1% PHONE (DAYTIME): ;7 "�� FAX NO. ARCHIT/ENGINEER: �� E ✓) t�= F E E /z ADDRESS: �% � � � 6 U2 A,- / ei,J�IC7: 4" V CITY: 119-- ✓t / STATE: )C7 k ZIP PHONE (DAYTI1,AE):r5 %V `i J9_ BONDING COMPANY: ADDRESS: CITY: STATE: ZIP MORTGAGE LENDER: ADDRESS: CITY: STATE: 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 coral with all applicable laws re tin construction and zoning. ,y OWNEU 4 (_'- 5 +—RtCTOR SIGNATUREWCON CTOR SICMT STATE OF FLORIDA ,l �Q G�.— STATE OF FLORIDA� COUNTY OF �1l� COUNTY OF The foregoing instrument was acknowledged before me this Li7day of ��w , 20 by , whd i ers6nally known to or who has produced as identification. Si&ature of Notary The foregoing instrument was acknowledged before me this ®day of 1Y, 20 by , whofis onally known o e or who has produced as identification. sigea4ire of Notary VtA th yaf&m Y14 pe Type or/Print Name of Nota Type or P .;.sL'?� YUMI STEFANIAK +�"'°';: YUMI STEFANIAK Conunission No. =�° 4�.-ea& COMMISSION # DD617300 Commissio o. : *= M omMI ; IION # DDS17300 d'EXPIRES November 26.2010 ;;� ��,.� EXPIRES November 26.2010 Service.com (407)398-0153 FloridENotarySernce.com NOTE: TWO (2) SI F IGNATURE MUST B APPLYING FOR THIS BULLING 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.