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Home My WebLink AboutAPPLICATION FOR PERMIT RENEWALoE USE ONLY: a r : , $; B DATE FILED; �l G �I� $} .. J PLAN REVIEW FEE: RECEIPT PERMIT NUMBER: CONCURRENCY FEE: RECEIPT NO:: I CERT.- CAP: i ALL INFO MUST BE -COM1PLE I . & FILLED IN TO BE ACCEPTED: 'EIVraj St, Lucie County.Building'and Zown- RKCL t 2300 Y4lgiliia Avenue �OR10, •. Ft. Pierce, 41; 34982-5652 MAY 2 12018 172-462-1553 Permitting .Department APPLICATION:for' .B.UILDING PE nty, FL. Lu cie Cou .CERTIFICATE :of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION c�' 1 11. - LOCATION/SITEADDRESSc:LL�rn 2. PROJECT NAME: can ' SITE PLAN NAME: 3..: PROPERTY TAX ID #: 9� :. O.On no 4. LEGAL DESCRIPTION attachextra sheets if necessary); :5 TD :1. ;12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ : ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION .. . [ ] ' ' RESIDENTIAL. [ . ] COMMERCIAL. [ ] INDUSTRIAL OTHER (SPECIFY). �06) - 1�C�OSCA 13. DESCRIPTION OF PROPOSED USE: + 14. 5Q. FT OF CONSTRUCTION: �`�. 15. SF. FT 1st FLOOR: 16. VALUE OF'CONSTRUCTION: $ \ I 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/oi.modify the indicated value of construction if -it is demonstrated that the submitted figures are not consistent with similar types of construction activities.1f the. value is $2500 or more; a. RECORDED Notice of Commencement must be submitted with'this application: SLCCD.V Form No.: 001-02 I f OWNER INFORMATION �(� rye S NAME: �G��II (S ADDRESS: CITY: �C,� _ STATE: iU n Lam, ZIP: '1 D PHONE (DAYTIME): - �� Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS B O FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): (_) I I CONTRACTOR INFORMATION j ST. of FL REG.CERT #: cc I z t I a) ) I I ST. LUCIE COUNTY CERT #: BUSINESS NAME: -\ ' d o \ \U l QUALIFIERS NAME: ADDRESS: \ i l e C a ` `9 CITY: Me 1 %"k CA STATE: �`1 ZIP: U� PHONE (DAYTIME): ( %-, �� D� FAX NO.'�Z I '1 a�' J� Email: 2 r n N Q C` l 6 I U m% n W co ARCHIT/ENGIN)EIER: 10S' \ ,nae-6mvzyi ADDRESS: �1, \ "� �6Q CITY �O V lQ V-\ 6�� -k STATE: ZIP: 33 q PHONE (DAYTIME): (� BONDING COMPANY: ADDRESS: CITY: STATE: ZIP: MORTGAGE LENDER: ADDRESS: I 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. i ' I CERTIFICATION: This application is hereby made to obtain a permit to do the workl 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 een 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 INGOOD 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 with all applicable laws regul OWNER OR CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this day of 20 , by who is personally known or who has produced as identification. Signature of Notary mation is accurate and that all work will be done in compliance construction and zoning. / _, STATE OF F] COUNTY OF The foregoing instrument was acknowledged before me this a3 day of 1 , 20— , by IQ S C� N who is nersonally-lmowfr or who has produced as identification. Signature of Notary Commission No. (Seal) Commission No. ,, DANIELLE SPEAK TARY FO@16 ° - STATE OF FLORIDA Comm# FF122121 ice �g� Expires 5/12/2018 NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERIBUILDER, 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. i I For specific instructions see appropriate permit checklist. I OFFICE USE ONLY BP #: SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 15T FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC LOT OF REC i LOT SPLIT LOT SPLIT Before 1/1990 After 1/1990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE AREA FEE FEE (RADON) LIBRARY PUBLIC,BLD I PUBIC BLD PARKS IMPACT IMPACT FEE IMPACT IMPACT FEE CORRECTION FEE FEE GENERAL SCHOOL ROAD i CREDIT Y N LAW. ENF IMPACT IMPACT IMPACT FEE FEE FEE (DRIVEWAY FIRE/EMS DRIVEWAY Y N ADMINISTRATIVE IMPACT REQUIRED (FEE VARIANCE FEE FEE SPECIFY MECHANIC ROOF i NON -CONFORMING MISCELLANEOUS SUBS ELECTRIC GAS LOT OF RECORD FEES REQUIRED PLUMBING FEES I I DATE SENT TO ADDRESSING: REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW—! REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED i i its INITIALS