HomeMy WebLinkAboutBUILDING PERMITSECTION:
ZONING:
FLOOD ZONE:
CST TYPE:
WATER:
TOWNSHIP:
LAND USE:
FIRM MAP #f:
OCCP TYPE:
SEWER:
LOT OF REC (befr 1190)
LOT OF.REC (aftr 1/90)
DECAL
LIBRARY
NUMBER
IMPACT FEE ..
i REPORT
PUBLIC BLDG
CODE
, /
IMPACT FEE
ROAD
GROSS ROAD
IMPACT ZONE
IMPACT FEE
/
DUE
SCHOOL-
19
CREi19,
IMPACT FEE
POLICE FEE
FIRE FEE
RANGE:
LOT CVG %:
1 ST FLR ELV:
MAX- OCCP:
SPRINKLERS
LOT SPLIT
REQ'D
PARKS
IMPACT FEE
HABITABALE
AREA
RADON)
n
'l
EDIT
N
MISC FEES:
f
ADDITIONAL
Y
J
N
SPECIFY;
0%1 __•.. _ —
PERMITS
REQ'D
REVIEWS - .
, , ;ZONING;""; `
J . ZONING- .--;
,''" PLANS
,.
REVIB D.BY..
EXAMINING
DATE COMPLETE
INITIALS
Y'
STORMWATE
R
LOT SPLIT
APPRV'D I 11
i
OO:l'F[ RE_&_ C
.t`ia..oa...�rr
PERMIT
FEE
RADON FEE �/
O
Y N j
TOTAL ROAD:
IMPACT FEE
I
TOTAL
SCHOOL
IMPACT FEE
TOTAL I II
POLICE/FIRE/
MISC. FEES i
TOTAL ALL
FEES
VEGETATION_,. SEA MANGROVE
TURTLE..
PLAN REVIEW FEE: RECEIPT NO.: d''t�`�_I �rERIVT _ IVUlt'IBER
CONCURRENCY FEE: RECEIPT NO.: CERT. CA-P. NO.:
AL-[IN-FO MU-.ST-RIF ['-OM-PL-L--T-L`� F1-LL-ED-1-N--T-0 B-E_ACCEPTED -
O�G ST. LUCIE COUNTY PUBLIC WORKS
BUILDING=B ZONING pEPARTIVIENT
<— -
2300 VIRGIN IA AVENUE
�0R1�P FORT PIERCE,'FL,34982-5652 _
772462-1553
ale
APPLICATION for BUILDING`PERMIT Lucia Caunty
CERTIFICATE of CAPACITYIZONING COYWLIANCE
PROJECT 1NFORMAT, 10N-
1. LOCATION/SITE ADDRESS: z-S0! .'of fiv �• - ir
�)0ce, 3�Q�{�
��
2. SID NAME: SITE PLAN NAME: 4Vti_» TV � ^
3- PROPERTY TAX ID#: ! 3Z�- 3�{1 pd� t oop
4. LEGAL DESCRIPTION attach extra sheets if necessary):,._ 3Y 3-vq YY
d�sE%y Lye, 3S .�1w qG: . t7S-
go7�
5: PLAT - 6. - -PAGE 7. :BLOCK - < '' . 8_ LOT
BOOK.-_.. NO.. -- NO-; - NO.
9. PARCEL SIZE: ACRESISQ FT. /G 4= LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: �L`7�tC�Ge' 3-1„
ii
�j
- W �l n ApJ 4l� tyla�e-�JUl;ac�v__�_"r=d�C�--. t-->� ��_.--•�__ -.,..
11. SETBACKS (ACTUAL) FRONT: BACK: /R1GHT LEFT
Z. $� I?.D.c-Z. SIDE �f •75' SIDE: 11 b - t .
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. 1st Floor. 16 FO
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 th
indicated value of constrrudon if it is demonstrated that the submitted figures are not coitsistent with similar types of construction activities. If the value is $250
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):
STATE: / - - = ZIP- _ 3
2-"
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW. .yL
FEE SIMPLE_ TITLEHOLDER: �/ 0 -e I �y� ���''C' � V-%04,
ADDRESS: 2-67d 1 -A elrt i s
CITY: f aw STATE: �L ZIP �Q 7
PHONE (DAYTIME):
CONTRACTOR -INFORMATION. Af
ST. of FL REGJCERT #:
BUSINESS NAME-
,.. , -
QUALIFIERS NAME:
ADDRESS:
CITY: - G C O r.y T 4= 0-00 ;Cz-
PHONE (DAYTIME): ff4o( !R AT q - 2-1 cl 1
CERT•#- v
STATE: �L C� f `• ZIPa 7.�
FAX NO. T-C11
ARCHIT/ENGINEER`. �p�2or�'C /" �'► Y
ADDRESS:LA
CITY: ,AM, _ STATE= , , ° P.
PHONE (DAYTIME): (1l, 2)? 17 - 57gd 2+
BONDING COMPANY: JA
ADDRESS:
CITY:
MORTGAGE LENDER -
ADDRESS: `-
CITY:
STATE:
",.STATE:
ZIP
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.
M
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.
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: Iith a
certify that all the foregoing information is accurate -and that all work will b one in compliance
ll applicable laws regulating con 1ujcficLn and zoning.
r�OW7NERI6O TOR'SIGNATURE
STATE OF FLqRIDA
COUNTY OF
The foregoing instrument was acknowledged
before rn th*i7i day o 20,�by _
ho is personally k e or who
has produced as identification.
'I
Signature of Notary
30e�\e. G111r�m1
Type or Print Name of Notary
Notary Public Title
SIG
STATE OF FLORIDA
COUNTY OF \Q
The foregoing i trument was acknowledged
r� _before me this tray of , 20-645, by
own to me
or who has produced as identification.
S gnature of Notary
Type of Print Name of Notary
Notary Public Title
Commission Number Commission Number
(seal) JOELLE GIIBSON (seal) JOELLE GIBSON JOELLI: GIBSON
Notary Public, State of Floflda votary Public, $to'- �` mtary Public, State.of Florida _
My Comm. Expires April 12, 2008 My Comm. Expir?3 April g!amm.'Expires April y 2, Zoos
No. DD309692 No. T%r- 51,00�?- 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.