HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONUAT1= FILED. g-I-•
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PLAN REVIEW FEE: RECEIPT NO.: EPERMITT-NUMBER:—�J-D$ -'
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
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® BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
'20R10Q FORT PIERCE, FL (
ZONING:
LAND USE:
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LOT CVG /o:
TAZ NO_:
155382=5652`
Q3ii LuWa CamV
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
APPLICATION for, BUILDING -PERMIT
CERTIFICATE of CAPACITY/ZONING- C-OMPLIANCE
CSTTYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
PROJECT INFORMATION.,.-
WATER:
WER:
SPRINKLERS
STORMWATE
1 _ LOCATION/SITE ADDRESS: Z 5 l CJI�'t v ]ema.� PI 2%rtor_ 3�
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2. S/D NAME: SITE PLAN NAME:
LOT OF REC (befr 1/90)
LOT OF•REC (aftr 1/90)
LOT SPLIT
REUD
LOT SPLIT
APPRV'D
_
3- PROPERTY TAX ID #: t 9 ZS" 35f o� -Oro =S
4_ LEGAL DESCRIPTION (attach extra sheets if necessary): sq Sg
'
'DECAL
NUMBER
LIBRARY
IMPACT FEE
PARKS
IMPACT FEE
PERMIT
FEE
/_ W.� �'
S�! Y �''I�� W • O ^ t" . %��N/ / Q'(�-•3 /`r'��! C� P
( REPORT
PUBLIC BLDG
HABITABALE
..r�
RADON FEE
5. -`,PLAT.- 6. ' P;4GE 7:.:BL�CK 8. LOT
CODE
IMPACT FEE
AREA
(RADON)
BOOK NO. NO.: NO.
- -
Y N
ROAD
IMPACT ZONE
GROSS ROAD
IMPACT FEE
C EDIT
TOTAL ROAD
IMPACT FEE
A
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS.
DUE
10. DESCRIPTION OF CONSTRUCTIONPROJECT ORWORKTI ITY.
SCHOOL-
N
.CREDIT:::»:<::<:»?`:ik::s»:>««::::r:>:«::>:::=>:>::::__=:::>:::<::::<::z:>::::>=::::::::<:;<;:::
TOTAL
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IMPACT FEE
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CH
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A
IMP C FEE -
T
_
1 1 SETBACKS
A CKS AC LEFT
(ACTUAL) FRONT: T: BACK: RIGHT R N
_
_
_
if 2•Iga )20 SIDE `ft.W SIDE:
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
MISC. FEES
Y N
[ ] NEW CONSTRUCTION [ J EXPANSIONIADDITION [ ] INTERIOR RENOVATION
ADDITIONAL
PERMITS
SPECIFY:
TOTAL ALL
FEES
[ ] RESIDENTIAL COMMERCIM[ ] L [�] INDUSTRIAL -.
IV OTHER (SPECIFY) prLuw�%m+' ( ,4 y &!;e rS{,Rtr3
RE
13. DESCRIPTION OF PROPOSED USE: ! g Anut &v,, �a ,i
.3 .
REVIEWS
ZONING
ZONING :.= PLANS
'VEGETATION
SEA' MANGROVE
14. Sq. FUCONSTRUCTION: Alk 15. Sq. Ft. 1st Floor.
REVIEWED BY -EXAMINI19G
TURTLE
DATE
COMPLETE
i
j
16. VALUE OF CONSTRUCTION: $ 2jtovoe
U
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
INITIALS
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indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value fs $2M
or more, a RECORDED Notice of Commencement must be submitted with this application.
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3LCCDV Form No.: 001-02
DWNER INFORMATION: /
C
ADDRESS:-/� _
CITY: " �' ` STATE: 0 - — -ZIP - -
PHONE (DAYTIME): ` r ! L54-7-7 57901
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: / STATE: P!_ ZIP ` T
PHONE (DAYTIME):��
CONTRACTOR INFORMATION
c,�0.�.�2gS �3 t C 3
ST. of FL REGJCERT #: �! ST. L•UCIE.COUNTY.CERT ft:
BUSINESS NAME:y!S J� �y 1 ��/f 1/S 4-4-GIF
r
iL 1: ' • /� -
QUALIFIERS NAME: ' Ao 1`` e-e - A r%e-
ADDRESS: 1M.. •V „I LI Imo' /' • �%° ,d fr.1V` " �O�E.'C - e 1
NAME:
CITY:
PHONE (DAYTIME):
ARCHITIENGINEER:
STATE: ��� ZIPS
21 Cr L FAX NO. !'� T — l �i �a Z► 1 ` 7
ADDRESS: � W A I L 1
CITY: s1 f
PHONE (DAYTIME):
:: _ . -"STATE:--_-:�" -• :ZIP` ` s.��82c
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP _
MORTGAGE LENDER: NJ�'
ADDRESS: 1�• e
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.
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:maybe-required_for-ELECT-R_ I_CAL,—PL-UMBI.NG;_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 LIE_ N
LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER'S AFFIDAVIT: certify that all the foregoing information is accurate and that all work will be ne in compliance
Wit h 11 applicable laws regulating c and zoning.
.. .. J Cam_ ..! ' ' .'t^ r !r/-_-� •'���'S.'2'� r�4.'•." . _-A �' f r ::' Y_w. ..Y
- WN_ER/CONT C R SIGNATURE CONTRACTOR SIG URE�"
STATE OF FL.QRIDA
COUNTY OF
The foregoing instrument was acknowledged
n before me thi�Eday o , 2065by _
tKObwho is personally_knbwn to me or who
has produced as identification.
(�!Signature of Notary
Type or Print Name of Notary
Notary Public Title
Commission Number
STATE OF F RIDA
COUNTY OF
The foregoing instrumen was acknowledged
� before me thisZiay od20&)�, by
who Is Dersonally known tome
or who has produced as identification.
ignatureoo—f Notary
C1'e rr(11�
Type of Print Name of Notary
Notary Public Title
Commission Number
JOELLE GIBSON
(seal) Notary Public, State of Florida (seal) Notary Public, State of Florida
My Comm. Expires April 12, 2008 My Comm, Expires April 12, 2008
No. DD309892 - No. DD309892
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATUR&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.