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Home My WebLink AboutAPPLICATION FOR BUILDING PERMITSECTION ZONING TOWNSHIP -�- RANGE MAP NO. LAND USE ! LOT CV 0/c TAZ NO. FLOOD ZONE FIRM MAP # /1 V ISTFLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC thefnre 1/90) LOT OF REC (after 1/9t11 LOT SPLIT REOUIRED LOT SPLIT APPROVED ADMINST ' LIBRARY PARKS PERMIT VARIANCE IMPACT FEE IMPACT FEE FEE REPORT PUBLICBI;B— c- ��/� HABITABLE RADON FEE nn ?tJ CODE � IMPACT FEE. � AREA (RADON) �`' • .�: Q , 1 GROSS ROAD CREDIT Y N --'i'OTAL ROAD IMPA FEE IMPACT FEE , ' DUE (p IMPACT FEE " SCHOOL CREDIT Y N TOTAL IMPACT FEE SCHOOL IMPACT FEE P CE FEE MISC FEE TOTAL 960FIIREFEEE J C�/� �UIJ(p• 2.MISC MISC POLICE/FIRE FEES . ADDITIONAL PERMITS Y N . .. SPECIFY - ` _ OJ 1 NS' TOTAL of ALL REQUIRED FEES REVIEWS ZONING ZONING REVIEWED BY PLANS EXAMING DATE COMPLETE n A• / INITIALS _ G VEGETATION I SEA TURTLE I MANGROVE DATE FILED: PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: (,0 — O U 1!0 CONCURRENCY FEE: Z�C -0-0 RECEIPT NO.: CERT. CAP. NO.: !` ALL INFO ST BE COMPLETE & FILLED IN TO BE ACCEPTED St.. Lucie County Building: and :Zoning, .. 2300 Virginia Avenue . `r�OR1� •! Ft. Pierce, FL 34982-5652 BY . 772-462-1553 . Lude ti*'• 9frikr APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: - a q W. Vv! 10 S A Y K C C 2. SID NAME: SITE PLAN NAME: 3. PROPERTY TAX ID #: 3 4 O S 4 2-1- O o 0 t - 000 - Z. 4_ LEGAL DESCRIPTION (attach extra sheets if necessary): - 5 3 (0 `f o E Vi or- n1E 04 o F ow 1/4 O( 51* 1JLF LESS WItDWAY &.O A•S 1rV 16K 2io-)9N-1 5. PLAT .6. PAGE7. BLOCK 8. LOT BOOK NO. NO. NO. 9. PARCEL SIZE: ACRES/SQ FT. 14. V 11 -LOT DRYIENSIONS >• _ j• i _ v 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: N C-W OF F I [ Ei - BIALhOI�Cr SNEt-t- - - • 11. SETBACKS (ACTUAL) FRONT: /�}a 9BACK: � SIDE / - SIDE LEFT: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ eNEW CONSTRUCTION [ -], EXPANSION/ADDITION" [ ] INTERIOR RENOVATION [ ] RESIDENTIAL { �_ 'COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) _ 13. DESCRIPTION OF PROPOSED USE: OFF 1-c. E 5 PA C- E 14. Sq. FtJCONSTRUCTION: �5�� 15. Sq. Ft. I 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 constnretion 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 CERTIFICATION: OWNER INFORMATION NAME: _ ?0 t L- �- 'FA o Y 1DR. A W A Y ADDRESS: Z'q 4 5 W. tN1 I �vJ A X D .CITY: fT . F1 EK-C E STATE: ZIP ' . 3 `{ j:21 PHONE -(DAYTIME) 0f) email:_�er►n�-�-rr-C d✓g.Ndy-bce�1'►t�s.-coM_ _ IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: VIJ / A ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): (_) CONTRACTOR INFORMATION ST. of FL REGJCERT #: C G -CA 13 -79 -1 _ ST. LUCIE COUNTY CERT #: BUSINESS NAME: _D9,6 JAY BR-611{Ee5 C0N5Tf_Mc_-nu.J QUALIFIERSNAME: - �Qpy'DkAVQQj ADDRESS: Zet y -s W - IM 10 W A4 K 0 . ill c_t Cti STATE- ZIP 311 Cl 8 1 r CITY: �, �- PHONE (DAYTIME): (7 7 L) 9 l/'i - $1 LFb FAX NO. 71 Z ' email: ARCHIT/ENGINEER:' 5TCLvE LICARSI ADDRESS: 1 O-71 O _5w W C 5TLA n1 D Bt_0 D. CITY: STATE: F ZIP _ -_,34 a)� 7 PHONE (DAYTIME): (172.) 7$ 5. 6 4 to 6- BONDING. COMPANY: N % A ADDRESS: CITY: STATE: ZIP MORTGAGE LENDER: nj PI 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 voided and returned to you by mail. 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 regulating construction and zoning. OWNER/CONOR.03NATURE CONTRA R SIGN TURE STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S'r. LNL 1 E COUNTY OF-. I_u C I E The foregoing instrument was.acknowledged before me this 3i day of M 11V , 20_94by V(41L d- DY 'DQAutlJy , who is personally The foregoing instrument was -acknowledged before me this 2sr day of . 019-f , 20y 1, by TRAY _P&A HJO `! ___,who is personally known to me or who has produced____� known to me or who has produced sas identification. as identification. D S-igna a of Notary o�yyrr'6Qi Notary Public State of Florida r Jennifer Pottorif Type or Print Name of Notary s ' Ex Commission DD445478 Expires 0911012009 - Sign a of Notary I r Public State,{ Ij fifer Pottorff Type or Prinf z A ° o Pi o911012009 Commission No... (Seal) Commission No. (Seal) ,v NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILING PERMIT AS AN OWNER/BUILDER, 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.