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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr ZONING: Aff LAND USE: LOT CVG %: TAZ NO.: FLOOD ZONE: FIRM MAP 1 ST FLR ELV: MAX HGT_ CST TYPE: OCCP Type. / MAX. OCCP: # OF FLRS: X WATER: SEWER: Z. SPRINKLERS STORMWATE R LOT OF REG (befr 1190) LOT OF. REC (aftr 1190) LOT SPLIT LOT SPLIT I REUD I I jAPPRV'D I DECAL LIBRARY PARKS PERMIT NUMBER IMPACT FEE IMPACT FEE FEE REPORT PUBLIC BLDG HABITABALE RADON FEE' CODE IMPACT FEE AREA -IRADON) Y N ROAD GROSS ROAD 'IEDIT TOTAL ROAD:' IMPACT ZONE IMPACT FEE IMPACT FEE DUE N .................. .. .......... ................. . ........... SCHOOL- CRE I .... . ....... .... ............... .... TOTAL IMPACT FEE SCHOOL .MSC IMPACT FEE POLICE FEE FIRE FEE FEES: TOTAL POLICE/FIRE/ MISC. FEES kewe I L Y N ADDITIONAL SPECIFY:PI TOTAL ALL PERMITS FEES REUD REVIEWS, t PLANS 'VEGETATION, SEA� I I MANGROVE 1).ZONING';. -, REVIEWED,BY.' ,, EXAMINING . 7.� TURTLE: DATE COMPLETE _eA INITIALS _ -DATE­­F­R_-EDn 3 PLAN REVIEW FEE: RECEIPT NO.: CONOURRENCYFEE: RECEIPT NO.: CERT. CAP. NO.: ..ALL INFO MUST BE COMPLETE u'FILLED IN TO -BE ACCEPTED CpG E_Cj Ks, • BUILDING & ZONING DEPARTMENT., 2300 VIRGIN!A AVENUE �0R10P FORT PIERCE; FL,,34982-5652 772-462-1553 APPLICATION for -BUILDING -PERMIT SVLUaIaCau,?� CERTIFICATE of CAPACITWOMING COMPLIANCE PROJECT INFORMATION 1 LOCATION/SITE ADDRESS: 12,6-b 1'0)QV_C0 FL 4—. 2. S/D NAME: SITE PLAN NAME: 1kn2im- 3. PROPERTY TAX ID#: 4. LEGAL DESCRIPTION (attach extra sheets if necessary):_ za. 391'3-9 SE s- w yq X Y I - -3 5 z PLAT" 6. -.-PAGE 7..:, 'BLOCK w ..8. LOT BOOK..., .-. , %- NO_. -NO.; NO. 9. PARCEL SIZE: ACRES/SQ FT. AM LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: Av(vce do 4 L (e t4�1 el w �k ij " % 11- SETBACKS (ACTUAL) FRONT- BACK: - - -- /RIC;HT LEFT /20 -C-7— SIDE 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: 14-. Sq. FtJCONSTRUCTION: l gd. 15. Sq. Ft. I st Floor: 16 90 16. VALUE OF CONSTRUCTION: $ The value of construction is used to determine the amount of permit fees to be assessed. SL 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 $250C or more, a RECORDED Notice of Commencement must be submitted with this application. 3LCCDV Form No.: 001-02 DWNER INFORMATION: NAME: ADDRESS: - CITY: PHONE (DAYTIME): FFM a­ W__ �,, STATE: ZIP Z Ce Z IF THE FEE SIMPLE+ TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. - FEE SIMPLE TITLEHOLDER:- ! / 0 -e I ADDRESS: • �lC�' — Q' STATE: ZIP �Q 7 CITY: I� PHONE (DAYTIME): (/ r 'q� T eG q 2-1 '7 Z' CONTRACTOR°INFORMATION.- ST. of FL REGJCERT #: G �c ©SS Z�tS �T._LUCIE,GOHNTY CERT _#- _ v LL BUSINESS NAME: !S� �"t ��� `�• �cs TC�'>►�4S �LC _ QUALIFIERS NAME: '7 ADDRESS CITY: Cj C O yty Glee"@' PHONE (DAYTIME): !q Ar u Ct STATE: �L -ZIPa FAXNO. ARCHIT/ENGINEER: �PQor�'C ' `•'� ADDRESS: CITY: .S_ �" t5 V V _ ._ STATE=- a. ZIR PHONE (DAYTIME): (� 2)� 7 G Vqpei Z BONDING COMPANY: /Y ADDRESS: CITY: STATE: ZIP LY 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. J� 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, ETC., not otherwise included with this building permit application. Thefollowing 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 1S 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: 1 certify that all the foregoing information is accurate -and that all work will ith all applicable laws regulating conj�sj tirZ and zoning. CQWNER/CO Tdf_ SIGNATURE STATE OF FLQRIDA COUNTY OF The foregoing instrument was acknowledged before m this��day o 20P5by who is ersonall k e or who has produced as identification- '(1 �ignatuMeofNotary Type or Print Name of Notary Notaryy Public Title STATE OF FLORIDA COUNTY OF )a.5 e in compliance The foregoing i trument was acknowledged r,� before me ihis nay of , 20A by T�OhU�t��rt' ,who ' own to me or who has produced as identification. 0 S -nature of Notary �11�fraLbr �,y -Type of Print Name of Notary Notary Public Title Commission Number Commission Number (seal) JOELLE G IBSON (seal) JOELLE GIBS0� JOELLE GIBSON Notary Public, State of Flatida ,votary Public, Star. "'. _Qtary Public, State -of Florida My Comm. Expires April 19,0013 My Comm. Expire; E$iFll te':l�q{¢mm. Expires April 12, 2008 No. DD309892 NO. ^,Nr' 5t ?- No. DD309892 , 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.