HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITI
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OFFICE USE ONLY:(f
DATE FILED: La
PLAN REVIEW FEE: RECEIPT NO.: PERNHT NUMBER:
CONCURRENCY FEE: -� ��' RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
(�. Pie Virginia Avenue Ft. Pierce, FL 34982-5652 �
�� 772-462-1553
APPLICATION for BUILDING PERMIT icux
CERTIFICATE of CAPACITY/ZONING COMPLIANCE `,
coc
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:& - Vol
2. PROJECT NAME: SITE PLAN1NA`N
3. PROPERTY TAX ID #: L rlT)P� - �1 - T1� �-1��
4. LEGAL DESCRIPTION (attach extra sheet% if necessary): (-�St�[j�
t O C _ -f-N
5. kAT BOOK I t 6. PAGE NO. r r ,��
7. BLOCK NO.
8. LOT NO.
C��a
9. PARCEL SIZE (ACRES/SQ FT.):1 • LOT DIMENSIONS:
10.
11.
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 0 kyxft tbn
BACK: RIGHT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: 7/
14. SQ. FT OF CONSTRUCTION: / ` / 15. SF. FT 1 st FLOOR:
16. VALUE OF CONSTRUCTION: $
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
UPDATED 6/25/09
J
OWNER INFORMATION
NAME: W
ADDRESS:
CITY: S) w (1�n � p� STATE: ZIP:
PHONE (DAYTIME)): (Z%I Z49 -,A-'/9 2 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: STATE: ZIP:
PHONE (DAYTIME): �)
I
I
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: y ` ^j--tQ)�� p �� -�-� ST. LUCIIE CO�UNNTYICERTn#: I � `l
BUSINESS NAME: 1 �t 1 X a'V zd Y l ) r r 1. i , 1 n l `..
QUALIFIERS NAME:
ADDRESS: v
/ 1
CITY: STATE: ZIP:
PHONE (DAYTIME): �� ( �[� FAX NO. Email: _
ARCHIT/ENGINEER
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (___)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
In'
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:
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 codsult with your Homeowner's Association and review §our 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.
V
OWNER OR CONIfAACTOR SIGNATURE
STATE OF FLORIDA-
COUNTY OF =
The foregoing instrument was acknowledged before
me this 0 day of ` t 20 f ,
by
who is personally known Ckc or has produced
identification.
ATURE
STATE OF FLORIPA-
COUNTY OF l l� •
The foregoing instrument was acknowledged before
me this day ofAQ0 20 L
I_6
ny
who is personally known -Pr has produced
r� as identification.
of
- KELLY
Commission No. _�� �F+� 48PAP� # Do r.94 4 _ Commission No.
11jJ,%KFLLY
COMMISSIon # DD 9941744
CvniroS Febn�ary ,,,,1,1,
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
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.
OFFICE USE ONLY BP #: i'6C L a- E
SECTION
(�z
TOWNSHIP
�.
RANGE
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MAP NO.
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ZONING
_
LAND USE
LOT CVG I%
TAZ NO.
w
FLOOD ZONE
FIMMP#
1ST FLRELV
6
MAX HGTK6
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
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SEWER
1' �j�l"9�
SPRINKLERS
I
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
(�
HABITABLE
RADON
PERMIT
CODE
1 �.JI
AREA
FEE
FEE
RADON
LIBRARY
LIC BLD
PUBIC BLD
PARKS
IMPACT
;MWPACT
IMPACT
IMPACT
FEE
CTION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
_
SPECIFY
/
MECHANIC �/ ROOF V
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC- GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING_
FEES
DATE SENT TO ADDRESSING: /
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
IZ
INITIALS
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