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HomeMy WebLinkAbout1004-0072 APPLICATION FOR BUILDING PERMIT• Ll OFFICE USE ONLY BP #: I lj .007a SECTION O� TOWNSHIP RANGE L4I MAP NO. L45C2S ZONING + LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC Before 1/1990 LOT OF REC After 1/1990 LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT CODE 8 t� HABITABLE AREA (RADON) RADON FEE PERMIT FEE LIBRARY IMPACT FEE PUBLIC-BLD IMPACT FEE CORRECTION PUBIC BLD IMPACT FEE GENERAL PARKS IMPACT FEE SCHOOL IMPACT FEE ROAD IMPACT FEE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT FEE DRIVEWAY REQUIRED Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE SPECIFY SUBS REQUIRED MECHANIC ROOF ELECTRIC GAS PLUMBING NON -CONFORMING LOT OF RECORD FEES MISCELLANEOUS FEES DATE SENT TO ADDRESSING: REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED f 1 DATE COMPLETED 1 INITIALS OFFICE USE ONLY :DATE FILED: . ��ti- PLAN REVIEW FEE: (07ou-coO RECEIPT NO.� ° BY 'ten � PERMIT NUMBER: 101 ``f- - 0 0 /s� 1?_' CONCURRENCY FEE: RECEIPT Q iC [ CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED �JG\6 CpG � St. Lucie County Building and Zoning lv D (/ 1 N 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 ► 772-462-1553 Vp# /00S-Qv/7 APPLICNTION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/IA�&G�e��� br`Jar. � PSch J� 'Z 1 2. PROJECT NAME [ (Q My' &COO VISITE PLAN ,�NAME: 3. PROPERTY TAX ID #:-iJOZ'�D1 — — ccd S 4. LEGAL DESCRIPTION (attach extra sheets if necessary):P 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): � LOT DIMENSIONS: 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:['LWL f whaf) �� S`I� I� a I - I o I u o to AD 1 i r�c�,ud�; �a S(,%ci� �a Mn. ors 11. SETBACKS (ACTUAL) FRONT: N MT BACK: `W RIGHT SIDE: Ntf LEFT SIDE:N W'i 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EX��jPANSION/ADMERCIALrDII,TION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] c('C yl0 (� iL� �CS��G1C�8i1 INDUSTFJI�i� [ OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: (ill 14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1 st FLOOR: 16. VALUE OF CONSTRUCTION: $ SCSI tu-)1 cl�' 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 c &c0 ;W0e14 — 6.31-0295el OWNER 1INFORMATION IN NAME: 1/ I, Ir, cyro f &Vidb M l n i ADDRESS: I C�noO CITY: STATE: _F�7ZIP: 1+95D PHONE (DAYTIME): (�� - �Z 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 REG.CERT #: AL D5CI BUSINESS NAME: QUALIFIERS NAME: _ ADDRESS: CITY: O% V PHONE (DAYTIME). ARCHIT/ENGINEER: i ADDRESS: CITY: Sho ✓9 PHONE (DAYTIME).. (! BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: re-r--s M19 ,-�-o©7� ST. LUCIE COUNTY CERT #: _ � ►� five � � � STATE: ZIP: 5(�9 4 D2_ FAX NO�� l2 � �� Email: •e U an SQ�c iQ f K4 STATE: STATE: STATE: M 19 Wo 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. • CERTIFICATION: 7,_J 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, FENCES, ETC., not otherwise included with this building permit application. St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. 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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. __ - - - - - - - - - - - - �- - - - - - - - - - - - - - - - - - - - - - - �---- OWNER OR CONTRACTOR SIGNATURE if/'4 � _' RACTOR SIGNATURE STATE OF FLOR STATE OF FLORID Y COUNTY OF N) COUNTY OF The foregoing instrument was acknowledged before methis '^8 day of 20 by i,poC KT f�1 Yl� Y (a U14who is personally known or has produced as identification. Signature of Not The foregoing instrument was acknowledged before me this day of Irl I , 20 l ©, by M � ( VW I 0 • &If who is personally known &_� or has produced as identification. Signature of ota Co—1�VN€WVti 10 1) Commission No. ti;r py� ea ANNECZEHWINSKI gxPs. °r MY COMMISSION # DD 889657 =* rr MY COMMISSION$ DO 889V ^+'`= EXPIRES: May 14, 2013 aa:, a EXPIRES: May 14, 2013 Rf ty4t`' Bonded Thru Notary Public Underwriters$ ; F,oe` Bonded ThN Notary Public Underwriters NOTE: TWO (2) SIGNATURES ARE REQUI NAT ARIZEED. PPLYING FOR THIS BUILDING PERMIT AS AN OWNERBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS. For specific instructions see appropriate permit checklist.