HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE ONLY:v
DATE FILED. '
S�U PERMIT NUMBER:
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County Building and Zoning ��
2300 Virginia Avenue
• jOlpRlOp` • Ft. Pierce, FL 34982-5652
n I 772 462-1553 t 6,100(3i'Im f,
1. ,
2.
3.
4.
5
7
APPLICATION for BUILDING PERMIT
i
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION n
3� b3i 3 �]81 C7��a�,cie; (�ve �rfi 1'itietcc 3�ci8 a
LOCATION/SITE ADDRESS: 225 F-i• S'bul-r , 6-F Sour otr key r'Me . Uri Oran ,
S/D NAME: NIA I ! SITE PLAN NAME: 'Bt [+" r- (4m maru aA ?cc 4- , LL Q
PROPERTY TAX ID Ro 24153-131-00 1-00(DA,
LEGAL DESCRIPTION
extra sheets if necessary): S e-e, 04-NSW E A 1 `I
PLAT 6. P I GE 7. BLOCK
BOOK i O. // n / NO.
7i / �i ��'Y'L/7
PAR L SIZE- A S/SQ FjT. '"�'�Q�'rcs LOT DIM SIONS -
10. DESCRIPTION OF CONSTRUC ION PROJECT OR
b-i u �tyiete ' '
8. LOT
NO.
600 -( 112: Z5
XN CW- wa y-'_6 u �-e
11. SETBACKS (ACTUAL) FRONT: BACK-. RIGHT- LEFT:
'SIDE, �SIDE 1-
12.
13
14.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE: �N QYtiIlOustS
Sq. Ft./CONSTRUCTION: 15.
16. VALUE OF CONSTRUCTION: $ -I - N 1 oo O
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
/0,3s0
Sq. Ft. 1st Floor:
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 $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
1V
' t
_ yT ... � 1 :ta��s!-• •. '"•' y F .:,,,^""._fit 'l
OWNER INFORMATION
NAME: �I t�t"M0K L m YYLn.r4 0 Jcc r k I U C.
ADDRESS: I z4s-o NU-1 Sow (L ,der Dr,
CITY: M 1wk STATE: ZIPII II '33 I i14
PHONE (DAYTIME): (305) 1-13-q-111 I email: k I k-e O'n • CO-
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: Q1r`'I-Q
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): ( )
CONTRACTOR INFORMATIO��
1-1
ST. of FL REG./CERT #: G I I S-T-. LUCIE COUNTY CERT #:
BUSINESS NAME: '6� I.OYt�s I� d)ihl Q 1 1 _T / e
QUALIFIERS NAME: E� ( �l s h-. Samc.Le z
ADDRESS: (2(4Sa W IA.) SOvkh R ti�r�X T)Y
CITY: rvl 1 Q yY l I STATE: F-' ZIP 3 3 ��
PHONE (DAYTIME): (3a6) 113 -q 711$ FAX NO. °5� $ 3-9 7$ 1 email:
ARCHIT/ENGINEER:
ADDRESS:
CITY: �+ �
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
50t4LL)Cttt
STATE: F L
Ntf !
STATE:
i
N /A
STATE:
ZIP
ZIP
ZIP
3ygsa
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.
G ! —
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.
I
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 FIN I NCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDIN YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APP ICANT 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' AFF AVIT: I certify that al the foregoing information is accurate and at 1 work will be done in compliance
with all applica le laws regulating construction and zoni g.
OWNER/CONTkt&OR SIGNATURE CONTRA O S NAT RE
STATE OF FLORIDA STATE OF FLORIDA 1
COUNTY OF A Aw i 1%4 COUNTY OF M u�iywi U+�
The foregoing instrument was acknowledged 1 The foregoing instrument was, knowledged
4efore me this day of � J, 20q,L`, by before me this � day of J u 20-AC, by
jtg A 5 s,% salt LV . ,who is personally_ v Who is erson
known to who has produced known t^ or who has prod ed�
as identification. I as identification.
ng4A - a) f �� )
II �- VlJ
Sign re of Notaryi Sign ture of Notary
via. L,WaV�z n f%-C .`12lf-
Type or Print Name of Type or
r Pue� CYNTHEA L. WALTZ W`3r"us Y�L. WALTZ
Commission No. I� eal ' COMMISSION # 00160202 _ Commis i5 90160202
OF4�0EXPIRES: October I 2006�0Fr`oe EXPIRES: October22,2006
1.9003-NOTARY FL Notary Service & Bonding, Inc. 1-8003•NOTARY FL Notary Service S Bonding, Inc.
NOTE: TWO (2) SIG S ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNERBUILDER, 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.
L4
SECTION
2
'TOWNSHIP
RANGE
11
MAP NO.
�
�
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
mow,
STORMWATER
LOT OF REC
LOT OF REC (after
LOT SPLIT
LOT SPLIT
(be ore 1/90
I/90
REQUIRED
APPROVED
c
,
e y-
ADMINST
LIBRARY
PARKS
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FEE
i
REPORT
PUBLIC BL�
HABITABLE
RADON FEE
CODE
IMPACT FE
AREA
J
ON
S
GROSS ROAD
CREDIT
Y
N
TOTAL ROAD
IMP CT FEE
IMPACT FEE
IMPACT FEE
�
DUE
SCHOOL
CREDIT
Y
N�
�� . �. -• ..-
� :��,� �.,_ �,.r='
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
L E FEE
FIRE FEE
..
MISC FEE
TOTAL
J
�j• �,��
j
�
�
POLICE/FIRE
MISC FEES
1 IG
AD ITIONAL Y
N SPECIFY
"
� TOTAL
Q/uwi 5i }
PERMITS
of ALL
REQUIRED
FEES
b J.g .s 'S
: � d R$° it
$ � t• f # . 3 1 ? : 2�` ik"°' € r� { k � 9
REVIEWS
y'
ZONING
ZONING.
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
�y�J1G
EXAMyIN
DATE
COMPLETE
dd7 h
� � f J
� "�
C
�
INITIALS
6FFICE':USE ONLY BP#: DO6."
:��a:... j .o�,:gym j .�u�r. � M..xo..
0o E M. F w u .�.
s,r F � fla,
Ea ou r oua SPRINKLERS