HomeMy WebLinkAbout0710-0338 VOID APPLICATION FOR BUILDING PERMIT CERIFICATE OF CAPACITYDATE FILED: Q /-�
PLAN REVIEW FEE: - RECEIPT NO.: PERMIT NUMBER: 0 70 7 ` V .31
SECTION TOWNSHIP RANGE MAP NO. CONCURRENCY FEE: RECEIPT NO.: CERT_ CAP_ NO.:
ZONING LAND USE LOT CVG pro TAZNO. ALL INFO MUST BE COMPLETE & FILLED, IN TO BE ACCEPTED
60
— — — - _ — St. u 'e CountyBuildingankZoningFLOOD ZONE FIRM MAP 4 IsrFLRELV MAX HGT
2300 Virginia Avenue - ,1
' fi3RlOP• Ft. Pierce, FL 34982-5652 I` o
CONST TYPE OCCUP TYPE MAX OCCUP 4 OF FLRS
r 772-462-1553
WATER SEWER SPRINKLERS STORMWATER APPLICATION for BUILDING PERMIT O
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT nn
efore 1/90) 1/90 REQUIRED APPROVED SCANNED
�� �v PROJECT ]INFORMATION
WA k" 161's County
1. LOCATION/SITE ADDRESS;
ADMINS T LIBRARY PARKS PERMIT
VARIANCE IMPACT FEE IMPACT FEE FEE 2. S/D NAME: [t i30 :i f o US'(12t R L SITE PLAN NAME:.P`� U�►J SFb 1tif Drr2 � N��+-SE
REPORT PUBLIC BLD HABITABLE RADONTFEE
3 _ PROPERTY TAX ID #: . ;Z 2 J 2 - 500 - O 00, ' - 000 7
CODE IMPACTFEE AREA ; 4_ LEGAL DESCRIPTION (attach extra sheets if necessary): Cq�E�U asr��S�Lr•r� L �'� L' - UPI T OfoG
(RADON)
3> CO. oQAG aP- N04-IC693 I&°y-2-99g(C0
SCHOOL GROSSROAD CREDIT Y N --TOTAL.ROAD
IMPACT FEE IMPACT FEE IMPACT FEE 5. PLAT 6. PAGE 7_ BLOCK 8. LOT
_ I
BOOK NO. NO. NO.
DUE
1 G /
SCHOOL CREDIT Y N TOTAL "' -" 9_ PARCEL SIZE: ACRES/SQ FT. e A LOT DIMENSIONS
IMPACT FEE SCHOOL
_ IMPACT FEE
POLICE FEE FIRE FEE MISC FEE TOTAL
I 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACT >-�CO X (00 YYiI'1C.
POLICE/FIREe CCr6
MISC FEES
ADDITIONAL Y N . SPECIFY. - - TOTAL 11. SETBACKS (ACTUAL) FRONT: BACK: 4 RIGHT: LEFT: c �%
PERMITS.. of ALL SIDE SIDE T
REQUIRED FEES
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
i -
[ ] NEW CONSTRUCTION EXPANSION DDITION [) INTERIOR RENOVATION
REVIEWS ZONING ZONING 'PLANS MISC. VEGETATION SEA TURTLE MANGROVE [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
REVIEWED BY EXAMING [ ] OTHER (SPECIFY) _
DATE 13. DESCRIPTION OF PROPOSED USE: �702A
COMPLETE 7/. 73
INITIALS /
14. Sq. FtJCONS-IRUCTION: ��y ;17_4 1.5. Sq. Ft. 1st Floor:
16..Ip VALUE OF CONSTRUCTION: 0,60 !IZ. % Z.
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
CERTIFICATION:
OWNER -INFORMATION
NAME 612L-'Wfm 15ur seo
ADDRESc/3(�L���`` I���� W � )#f!' l
.CITY:,* D��C.�'rV� STATE:.. ..Y. L. ZIP " 3`( 7oZ
PHONE (DAYTIME): / J� — �( �� 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:
- -J
PHONE (DAYTIME): �)
CONTRACTOR INFORMATION
ST. of FL REGJCERT #: �!_ D 3 5/ � 0
STATE:
ZIP
ST. LUCIE COUNTY CERT4/ff_ Yi1A—k
BUSINESS NAME: �I /2!) (� � � �v �vwf_
QUALIFIERS NAME'
ADDRESS: Y 75 1:56:-)
CITY: D �gc !'i"�STATE- f�C- ZIP
PHONE (DAYTIME): (� 6 5y—!y V FZO FAX NO.,95 �;G 3 ��� / email:
ARCHITIENGINEER: " C%)W N D EP- P IVA-^1611
ADDRESS::n 7A/�3 N o L��% -j�foU&7 D)e' _
CITY: STATE: T x ZIP
,PHONE (DAYTIME): (_�
p� � 9
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 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 APPLICANTi 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 VIT: I � ify that all the foregoing information is accurate and that all work will be on n compliance
/ with all applicable laws regulating
OWNEWC,@NiTR+ � R SIGNATURE !€ " ;; :*
OI3� IGNA URE
STATE OF FLORID'
STATE OF FL A
COUNTY OF
COUNTY O
The foregoing in trument was acknowledged J ��
o
�t a foregoing ins rument was-acknowled ed
/May 20by
be ore me this da of 20ffby
fore me this off ,
.qlYl0 0 w is personally z z j
o is personally
known to a or who has produced o =
m { own to or who has produced
(c� '�/�, 0 k [ (°� as identification. a o 9;
, �i}'�` as identification.
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31`z!Q
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Signature of
v o natu tpf 14otary
Type or Print ame of Notary
a or Prin_ ame of Notary
Commission No.. (Seal)
Commission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IMTHE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.