HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITa l . wI-it UUUNTY
APPLICATION for BUILDING PERMIT
I SECTION: I /^ I TOWNSHIP: I 3(� I RANGE:
I ZONING: I I H - I LAND USE: I / Nd ILOT CVG %:
FLOOD ZONE:
CST TYPE:
WATER:
FIRM MAP is
OCCP TYPE:
1 ST FLR ELV:
OCCP:
BP #:
0 MAP NO.: 1--34
• i
TAZ NO.:
MAX HGT:
# OF FLRS:
STORMWATER
13Yr - L(-7
SGANNED
- E DATE FILED: /v BY
PLAN -REVIEW FED— ECEfPfi FTQ.:� r�u� .ran ER:
.� . -
—a
CONCURRENCY FEE: RECEIPT NO.: - CMT.-CAP. NO:
�• ST. LUCIE COUNTY kAl`
DEPARTMENT OF COMMUNITY DEVELOPMENT
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LOT OF REC (befr 1190)
LOT OF REC leftr 1/90)
I
I LOT SPLIT
I
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLDG
HABITABALE
RADON FEE
CODE
�%�
IMPACT FEE,
AREA
-- -
(RADON)
'
ROAD
GROSS ROAD
CREDIT
y
N
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DU
f
�1C�
.
Y
SCHOOL
CREDIT
TOTAL
IMPACT
SCHd
-
... �.��• '.X�1 ''�
gR :.I1�'�IMPACT
FED• l
;. ►!'� stt • .
POLICE FEE
FIRE FEE
MISC FEES.
TOTAL -
1`
w: -
'��-..����_
POUCWIRE/.
_ =a�.4� :.�_:
- -
MlscSEES �;�•
ADDITIONAL
Y
N
SPE
'.
TOTL ALL
PERMITS
:� �i�'• i
zti °t v'-'
SA FE!1t tii4'�.
• , a
REWD
REVIEWS
ZONING
R.
DATE
-y S
COMPLETE
INITIALS
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-- - - - - -- —VEGETATION- SUI=TURTLE r -N7AN1
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING. COMPLIANCE
PROJECT INFORMATION
! G qo G✓. in�.,�A �E�c.� �L.
! I. LOCATION/SITE ADDRESS: 5 �O •—
�' C+ w �=tP C'Ii►,.a�t-to-a...� 7
2 S/D NAME: /mop€z. 44-` 6 • S PLAN E:
i.
7
3. PROPERTY TAX ID #: �4oG So/ OD 4-0 ODDS 6100
4. LEGAL DESCRIPTION (attach eats cheats fl neoeeeary): ��g I Gang, /?Jio�„ L,...ro�a 5 Sens ✓ D�'
-74 •s, eQD-67, pe"- , 1-1234- ,. 5: -/ a G1 �r 4�; .. .
S. PLAT 6. PAGE 7. - BLOCK - 6. L r
BOOK 4 NO. 3¢ NO. NO.
i
is
9. PARCEL SIZE: ACRES/SD FT. 4 76 Zo7 S .6-r10 LOT DIMENSIONSz�i. ,P.� X8• ��
? .I
10. DESCRIPTION OF CONSTRUCTION PROJECT OR .WORK ACTIVITY:
772�g2
11. SETBACKS (ACTUAL) FRONT: 3• 0-1 BACK RIGHT -LOA EFT GO
SIDE SIDE:
12 TYPE -OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
` [ ] RESIDENTIAL [ j COMMERCIAL [ ] INDUSTRIAL
OTHER (SPECIFY) f•e �-r ��.�,.ti. tr.ytce r.a„/3� �a�,2
13. DESCRIPTION OF PROPOSED USE: 7;
14. Sq. FL/CONSTRUCTION:, 15. Sq. FL 1st Floor:
6.
y -
16. VALUE OF CONSTRUCTION: $ /on. 02y \
The value of construction N used b determine 1M amount of pemllt tees b be, eseeeeed. 8L Lade k:amly reserves the rlgM to question, and/or modify the
Indicated value of construction ti It is demonstrated that the submttled fipum we not oonsh0ent wah elmller types of construction madvities.
1
+ ST. Vjr. F. COUNTY BIACOV Form No.: OM-02
APPI i-PYTION for BUILDING PERMIT
ST LUCIE COUNTY
APPLICATION for BUILDING PERMIT
OWNER INFORMATION: /
NAME: �rar�e.oF,r� i �rrsr
ADDRESS: Gr �� �J �oLSS �✓ �r� /7�0
CITY: " - -
� Z STATE: ZIP gr
PHONE (DAYTIME): �j 6/ �7,j'� 29 v 33417
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE R USTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: %�.d6Nksy, �„a► ;,� �,�,,-,Z
ADDRESS: �� «: : �� ��..r.— 1 2 26 N
CITY: &2LI� ZIP
I
CONTRACTOR INFORMATION _
ST. of FL REGJCERT 0: �'i�'G D/ 1,G, SIB ST. LUCIE COUNTY CERT #:
BUSINESS NAME: .et row Z!r.�
QUALIFIERS'- NAME:"
ADDRESS: y . %a0 72) -.
CITY: STATE: 1 Z.. ZJP
PHONE (DAYTIME): 1�d71 773 --2C707
ARCHITIENGINEER:� >cicrnFi�s�
r
ADDRESS: _74 d 1•�iyy. 7S .IJ. moo. S
CITY: �/� �`-� STATE: ZIP
PHONE'(DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER:
ADDRESS:
CITY: STATE:- ZIP --
IMPORTANT NOTICE When a permit is issued and it is not picked up within Q 0_M
after notification it will be voided and returned to you by mail.
ST. LUCIE COUNTY
APPLICATION for BUILDING PERMIT
CERTIFICATION(:,.
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certiffcatl
of capacity, if applicable, for tale 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 peTnits 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;7—accesso1
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to anothe
non-residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYIN(
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAII
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 THI'
PERMIT YOU PROMISE IN GOOD- FAITH TO DELIVER A COPY OF THE ATTACHEI
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJEC'
TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done I
compliance with all applicable laws regulating construes and zoning.
OW CON RACTOR ESIGINATURE
STATE OF FLORIDA-
COUNTY OF BP&V.4jW
The. foregoing instrument was acknowledged
before me this JpWday of 612r. j9&,, by
JfCAA.eCS LbiWb4Fwho is personally known to me
or who has produced as
identification.
Si ature of No
Type or Print Name of Notary
SIGNATURE
OF B1s? YARD
The foregoing instrument was acknowledged
before me this 620%ay of . 19,&. ,
by'"MOA AS R; PA6E , who is personalh►
know to me or who has produced
as identification.
,- zw',
gn Notary
re of
Type of Print Name of Notary
Notary Public Idle Notary Public Title
Egg
C$�nnrCM
ri� JO a��ra>± PAGE
CC ss�ir e?38 Commissi0�n�I�Umber JO ANNE AGE
EXPIRES MAY 09. 2000 ;,„ , :• 1, , ?o �COMMISSIOIiI CC 553738
(seal) f '; i $ EXPIRES MAY W.
ATL4= SONOM Co.. INC, - ( 1) �� BONDED THRU
f OFFS AM AMM BONDING CO.. INQ
NOTIE:, ; WO1 (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
W, APPLYING -.'FOR 'THIS BUILDING PERMIT AS AN° OWNEWBUILDER, THE OWNER MUST PERSONALL
A.POFq.R-TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.