Loading...
HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE USE ONLY ;-- SECTION ZONING FLOOD ZONE. CONST TYPE WATER LOT OF REC Before 111900 REPORT CODE Y 4 TOWNSHIP (1 RANGE MAP NO. LAND USELOT CVG % TAZ NO. 4 ® FIRM MAP # � 1ST FI.R ELV MAX HGT OCCUP TYPE I ' I MAX OCCUP I I # OF FLRS SEWER I L-4 I SPRINKLERS I I STORMWATER LOT OF REC I I LOT SPLIT I I LOT SPLIT After 1/1990 REQUIRED APPROVED (� i HABITABLE v 1 AREA .n PERMIT FEE LIBRARY PUBLIC BID '2 i ,'j3 PUBIC BLD PARKS IMPACT 3 IMPACT FEE IMPACT ��� IMPACT FEE CORRECTION FEE FEE N GENERAL SCHOOLLAW MPACT v 115 IMPACT ��► CREDIT Y N ENF IMPACT 13 [FIUW,/EMS FEE FEE. DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE PACT' i ., REQUIRED ` - FEE VARIANCE FEEEE SPECIFY MECHANIC —;z ROOF NON -CONFORMING MISCELLANEOUS SUBS REQUIRED ELECTRIC, GAS PLUMBING "" ` ' LOT OF RECORD FEES FEES DATE SENT TO ADDRESSING: REVIEWS ' . FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW '' . 'REVIEW' _REVIEW REVIEW REVIEW. REVIEW - DATE COMPLETED .% 2 ell- r Q DATE FILED PLAN REVIEW FEE: `)�_ . RECEIPT NO.: j3 q PERMIT NUMBER: CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED r _• t PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING &CODE REGULAtIONS DIVISION • SCANNED 2300 Virginia Avenue .- Ft. Pierce, FL 34982-5652' BY 772-462-1553 Si Lucie Coin' �• APPLICATION for BUILDING PERMIT u CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMg ON 1. LOCATION/SITE ADDRESS: T LI CEA&I ,C-STAT�S ' Lr %, - 0,10 2. 3. 4. PROJECT NAME:,4t//4loAf rN00€L "C SITE PLAN NAME: PROPERTY TAX ID #: —M0 3 - 54Q - ©D/,f-- ©DO 3 EGAL, DESCRIPTION (attach extra sheets ifnecessary): ► U 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. S. LOT NO. 15a 5c� � '� ti 9. PARCEL SIZE (ACRES/SQ FT.):.,?f 7 •C LOT DIMENSIONS: 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: L'OA9 P4672F S'iNGc� F/�,t'i�Y �'r�ss'�D�,vCC-' 3 Sra�2Y r�rf86 SF 11. SETBACKS (ACTUAL) FRONT:Ad, i2/ BACK: /Z 69 RIGHT SIDE: 3 9 / LEFT SIDE: _ 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION JjQ RESIDENTIAL [ ] COMMERCIAL 1INDUSIRML [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: S/n/Guz 14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR 16. VALUE OF CONSTRUCTION: 400 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 RECORDEDNotica ofCommcocement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6125/09 OWNER INFORMATION f NAME: ri T� Ay, 4 LcAl , L Z L' V ADDRESS: q9 L� 5r%t/e sir ,J CITY: s7AW)C0PR—V STATE: kragTyGKY ZIP: PHONE (DAYTIME): ( 3 S 35 5S Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNEK) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): L� CONTRACTOR INFORMATION ST. of FL REG.CERT #:' C&C /S D 75gc/ ST. LUCIE COUNTY CERT #: 96 BUSINESS NAME: SC" O T% 1-1`Gy/S ca 1 677eyC l— I, `� L QUALIFIERS NAME: /�( �CDTT ZIEWI S ADDRESS: 9 t� g C'1�d.E�% dy2�� CITY: L6�C,4 47-C1AC STATE: BF: PHONE (DAYTIME): (W 7 72- G%a'16D—FAX NO ,56/- Email: vk�ot1 a &*L*Ie ARCHIT/BNGINEER ADDRESS: CITY: PHONE (DAYTHOE): (_, _ BONDING COMPANY: / ADDRESS: CITY: MORTGAGE LENDER ADDRESS: CITY: STATE: STATE: STATE: AP Ar ZIP: EWPORTANT 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 a. CERTIFICATION: r 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 GOODTAiTH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. V OWNER OR CO CTO SIGNATURE CONTRACTOR SMNAfURE STATE OF FLORIDA. — STATE OF FLO A- - - COUNTY OF .`it, .j a e 1,e COUNTY OF -_L i)! i -P The foregoing instrument was acknowledged before me this I day of f C / 20_j2_, by 1 who is personally known or has produced 1('.p��� as identification. Signature of The foregoing instrument was acknowledged before me this r'day of 20by who is personally known or has produced akI � 1�Ll tz i I 1 C eA 52 o as identification. Signature of Nota Commission No. Rya .•'"��,.(Se»yIOREY WILLMOT Commission No. ;`'' : AIJf� EY WII.I�MOT MY COMMISSION # DD973168 =•; MY COMMISSION # DD9731 EXPIRES March 21, 2014 ;��j'�p q — (407)39"m Floridallotery3ervice.w %'w" EXPIRES March 21, 201 �.m NOTE: TWO (2) SIGNATURES ARE ATURE MUS FL IFFA99900MR— THIS BUILDING PERMIT AS AN OWNER/BUILDER, 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 OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist.