HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATETE FILED a is I ��
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AN REVIEW FEE: cif RECEIPT NO.: PERMIT NUMBER:
NCURRENEIPT NO.: CERT. CAP. NO.:
ALL INFO MIDST BE COMPLETE & FILLED IN TO BE AC,wCEPT�_E��D
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N St. Lucie County Building and Zoning,`__,
,,. 2300 Virginia Avenue -
<ORIO�' r J Ft. Pierce, FL 34982-5652 �1
LJ 772-462-1553
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APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITYIZONING COMPLIANCE
// PROJECT INFORMATION
I., LOCATION/SITE ADDRESS: 1� O� K U l ,/C t �y
2. '' PROJECT NAME: ki kOwd GO OO CJ' h SITE PLAN NAME: _ �Oi� T1e(� 5Qre.._
3. PROPERTY TAX ID #: (�i 3 �o �o C� 1 C 05q / C OG nC3
4. LEGAL DESCRIPTION (attach extra sheets if nece ary): fC e S koneS B K 2
5. PLAT BOOK 6. PAGE NO. ; .7. BLOCK -NO. ,z.. 8. LOT NO.
3CI
9. PARCEL SIZE (ACRES/SQ FT.): Z LOT DIMENSIONS: 6 0 X / O
10. 1I COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR W RK ACTIVITY: C_o✓►� -ram. c -
SETBACKS (ACTUAL O T" ALB � �FI�I E: %, 7
it
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
l NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
i
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: _ ' tat, 40 m, i l l �P. 5 /t4.• eI- V
SQ. FT OF CONSTRUCTION: "2- Q 2-0 C'rb 15. SF. FT 1st FLOOR: L o 2-C)40
16. VALUE OF CONSTRUCTION: $ j 6
-1 q3q. Ov
The valu' �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 nstruction 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
RECOR D Notice of Commencement must be submitted with this application.
Form No.: 001-02
OWNER 1 FORMATION
NE: •
W,-
AMev
CITY: Vff Z,4--/ / fiL STATE: � �/ l y -t ZIP:
PHONE (DAYTIME): Cit- . �� d Email: ���(^'��W6t7cQI1�1 ��1fVr� awl
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE;=PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: SA A
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: 1 ST. LUCIE COUNTY CERT #:
BUSINESS NAME: —ZP "�)I� /bi C J1�' ►mac �n C
QUALIFIERS I�7AME: i, , �.pl BW
/
ADDRESS: 200q G Q U rq dy 4 n/ �J
CITY: STATE: ��- ZIP:
PHONE (DAYTIME): (M `�J G g FAX NO. ,2)7, Email:
ARCHIT/BNGINEER: q A
)) ' 1—"%-y' ' A.
ADDRESS: Rap /-3 1 �TIwC�Jr
CITY: STATE: ZIP: 3 V
PHONE (DAYTIME): (�1-
$$
BONDING COMPANY:
ADDRESS:
CITY: STATE: _ ZIP: I
MORTGAGE LENDER:
ADDRESS:
CITY: STATE:
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after
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 Ge;pe•formed 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 ihi's building permit application.
t. Lucie County makes no representation that its granting of a permit will authorize the permit -holder to build the subject structure
hich is in conflict with any applicable Homeowner Association rules, bylaws, or any, covenants that may restrict or prohibit such
tructure. Please consult with your Homeowner's Association and review your deed: for__a y restrictions which may apply.
following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
cores (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
-ntial use. -
'ICE TO OWNER: FAILURE TO RECORD A NOTICE OF-COAD4ENCEMENT MAY RESULT,IN. YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOtR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
2E 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.
?,R'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
wit applicable laws regulating construction and zoning.
:R OR CONTRACTOR SIGN E 'O�NtR2 VCT•OR SIGNATURE
ATE OF FLORIDA
)LINTY OF
foregoing instrument was acknowledged before
this n_n1day of
is personally known
known
r� f__
or has produced
identification.
STATE OF FLORID
COUNTY OF--,'*
The foregoing instrument was acknowledged before
me this day ofh_ , 2d 2, ,
by J,a12 A '6
who is personally known or has produced
�ature of Notary " . `Sign re of of y
.nna SHARI BLIZZARD
(pRV P[ a i
Public - State of Florida Commission No.
mission No. == a � (5�)Y
• My Commission Expires Apr 10, 2010 LORIEA. GERSTEMEIER
Commission # DD 539038At; *__ -myCOMMISSION # DD 514317
",OF �� A'� o EXPIRES; Februa 14, 2010
Bonded By National Notary Assn. Bonded ThYu NOtBry ry
11, E: TWO (2) SIGNA LIRE ARE REQUIRE . AC S G ATURE MUST B
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERIBUILDER APPLICANTS.
specific instructions see appropriate permit checklist.
. I
R
OFFICE USE ONLY BP #:ix(CL, - bt
SECTION
TOWNSHIP
A
RANGE
LAP
MAP NO.
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LAND USE
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LOT CVG %
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TAZ NO.
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FIRM MAP #
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1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
LA)& -
SEWER
L
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
v
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
t
AREA
FEE
FEE
(RADON)
LIBRARY
PUBLIC BLD
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PUBIC BLD
PARKS
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IMPACT
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IMPACT FEE
IMPACT
IMPACT
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CORRECTION
FEE
FEE
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ROAD
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CREDIT
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NO,
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IMPACT
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IMPACT
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DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
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ADMINISTRATIVE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF ✓
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC V GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING _ 4
FEES
r
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
1r.
RECEIVED
I
c 5 6
DATE
IZ 1
COMPLETED
INITIALS