HomeMy WebLinkAbout23050811 APPLICATION FOR BUILDING PERMITBP #:
OFFICE.USE:ONL
ZONING:
LAND USE:
L/
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #
1ST FLR ELV:
MAX HGT:
CST TYPE:
jf!�PTYPE:
MAX. OCCP:
# OF FLRS:
STORMWATE—
R
-
WATER:
SEWER:
SPRINKLERS
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
READ
LOT SPLIT
APPRV`D
DECAL
NUMBER
LIBRARY
IMPACT FEE
-�
PARKS
IMPACT FEE
PERMIT
FEE
REPORT
CODE
/
f7
I
PUBLIC BLDG
IMPACT FEE
HABITABALE
AREA
(RADON).
RADON FEE
ROAD
IMPACT ZONE
GROSS ROAD
IMPACT FEE
DUE
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
SCHOOL
IMPACT FEE
CREDIT
Y
N
_
::
TOTAL
SCHOOL
IMPACT FEE
POLICE FEE
-44
OFFICE .USE ONLY: SCMWFJJ
DATE FILED: U-21-eC"It\' PERMIT NUMBER:
PLAN REVIEW FEE: RECEIPT
/4T *7T f4 A In N%1
ALL INFO MIST BE COMM I t 5L rILLcly In ■ %F AP`-'���
ST. LUIC WORK r rN-
CIE COUNTY PUBLy
'4
BUILDING 8 ZONING DEPARTME
2300 VIRGINIA.AVENUE
FORT PIERCE. FL 34982-5652
'20R10Q' 5614624553 46E D
APPLICATION'for. BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS: 50567 AIOAI X I A tvz�7gf�cE
IF
// / ,,.. f7/
SITE PLAN -�-
2. S/D NAME:
3. PROP - � TAX�'ID O:
!Z:::
4, - DESCRIPTION (atta'chext��etsn .neces3arjr):
5. PLAT 6. PAGE 7. BLOCK 8: LOT
BOOK NO.- NO. NO.
9. PARCEL SIZE: ACRES/SQ .FT. LOT DIMENSIONS .
10: DESCRIPTION OF CONSTRUCTION PROJECTOR WORK -ACTIVITY: � ELIOXA 0001-T. (�e
-F c.
11. SETBACKS (ACTUAL) FRONT: BACK: LEFT
SIDET SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ J NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ J INTERIOR RENOVATION
Y N (] RESIDENTIAL 4zJ COMMERCIAL [ ] INDUSTRIAL
ADDITIONAL SPECIFY: TOTAL ALL �� /n .. R4 �J�► �.0 S
PERMITS FEES OTHER (SPECIFY) _
REQ'D
i 13. DESCRIPTION OF PROPOSED USE: 0^two H "'r'0-4 -
REVIEWS ZONING ZONING • PLANS VEGETATION, SEA MANGROVE jl 14. Sq. FtJCONSTRUCTION: 15. Sq. Ft. 1st Floor:
REXIEWED BY EXAMINING TURTLE
DATE ry] /�lh�
= 16. VALUE OF CONSTRUCTION: $ �-�J4 000. Dc7
COMPLETE f� vc/ 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 3250C
or more, a RECORDED Notice of Commencement must be submitted with this application.
INITIALS
TOTAL
MISC FEES: I 'vv I POLICE/FIRE/
0
3 lbz
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: STATE: zIP
PHONE (DAYTIME): ( 1
CONTRACTOR INFORMATION
ST. of FL REGJCERT ST. LUCIE COUNTY CERT #: O? V
BUSINESS NAME: (1A4^6 ir-
QUALIFIERS NAME: AeYA".1 0/1 A -SF_
ADDRESS: l3o V'Z S vi •f a_.21
CITY: I -CST ?.441_f L/eAnll STATE: zip -
PHONE -(DAYTIME): 6-6/1 FAX NO. _56 6ei4Z - 93 6G
ARC NGINEER: ,SCR✓G clAAV
ADDRESS: 75_/ if/F�.e l�il.4�G /i/�/oI, ,5u• —,r2 Z C
CITY: A494 1 • BL AL' 4. - STATE: 23P 3 3 i�0 8
PHONE (DAYTIME): ( S6h 9Ak6o
BONDING COMPANY: /� A
ADDRESS:
CITY: STATE: 23P
MORTGAGE LENDER: MLA
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 voidvoidgd and returned to you by mail.
CERTIFICATION:
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 re ulating construction and zoning.
OW R/C�N CTOR if,
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF -T&0,kf`11J lZ\-v-C4r
The foregoing instrument was acknowledged
before me this 3 day of M, 20 3,, by S;
W r k �� who is RgM2ngLv kn wn tome or who
ahrodauceda. as identification.
Signature of Notary
Type or Print Name of Notary
STATE OF FL IDA n
COUNTY OF a C
The foregoing instrument was acknowledged
before me this Lq_ day of 20(�, by
who is erson ly known tome
o�'o has duced d as identification.
of
Type of Print Name of Notary
Notary Public Title Notary Public Title
D 31L b2_�ClCommission Number Commission Number
(seal)
.0 py c J KIM N. ME12ER (seal) ai��y'•., DEBRA ROBERTS
r iY COMMISSION # DD 136270 MY COMMISSION # DO 119845
EXP RES.June 27,2005
B.&d Thru rotary Public Underwriters erwrer-,. e,- EXPIRES: July 5, 2006
�ry;�` Borded Thru Notary Publb Underwriters
NOTE: TW I ED. EACH SIGNATURE MUST cf
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAK
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF, THIS APPLICATION.