HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY
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RECEIPT NO.: PERMIT NUMBER:
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ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPT D
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St. Lucie County Building and Zoning
MAX HGT
2300 Virginia Avenue
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Ft. Pierce, FL 34982-5652
SCANNED
-- - --- -OFFERS- ----
---- --- -
772-462-1553 -
-- -- - -----
_- _ -BY
St Lucie Count
STORMWATER APPLICATION for BUILDING PERMIT
LOT SPLIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE
APPROVED PROJECT INFORMATION
' PERMIT 1. LOCATION/SITE ADDRESS: �� t� i
FEE 33� 2. S/D NAME: Fn;rwa�.1S �1 1tlar,r� Clex�ITE PLAN NAME: seve,»A rr IIx
RADON FEE - l 3. PROPERTY TAX ID #:J
4. LEGAL DESCRIPTION (attach extra sheets if necessary): SAVANNA CLUB - PHASE 8
SCHOOL
IMPACT FEE
NAV h
-•
GROSS ROAD
IMPACT FEE
DUE
V
I d ,
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
10 5-7 °
I
�
8. LOT
5. PLAT 6. PAGE 2 7. BLOCK j Q
BOOK 4B NO. NO. �V NO. t O
DR ((Qlo OR (?jaq
9. PARCEL SIZE: ACRES/SQ FT. O 15 LOT DIMENSIONS
ro o00.OD
10. DESCRIPTION OF CONST UC ION P JEk`C�T nOR WORK ACTI ITY:
� bbi � lr h UI Ili � f�W
SCHOOL
IMPACT FEE
"
j g-�D .
CREDIT
Y
N
TOTAL;
SCHOOL
IMPACT FEE
1 °431� .
::;.: ;. ; '•:;:.
POLICE FEE
LAW
i pp
` � W �
FIRE FEE
� �
q 7 i
MISC FEE 131 nhS ✓
2.0 0
TOTAL
POLICETIRE
MISC FEES
� 1 S .
_LEFT -
11. SETBACKS (ACTUAL) FRONT: BACK: J RIGHT: y
cS0 SIDE �'y SIDE ® c
' (Check all Late boxes)
TYPE OF CONSTRUCTION (Ch appropriate es
OVATION
[ CONSTRU [ ] EXPANSION/AD [ ] INTERIOR RENOVATION
NEW CONSTRUCTION EXPANSION/ADDITION
[ RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
ADDITIONAL
PERMITS/
REQUIRED
Y
N
SPECIFY
TOTAL
of ALL
FEES
-
_.;.... _ .... _ .... _. ;..... ........ . � .. =
REVIEWS
ZONING
ZONING
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMING
li
[ ] OTHER (SPECIFY)
DATE
COMPLETE
* to-06
�-�
/� D '
? �' '
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: v 15. Sq. Ft. 1st Floor:
INITIALS
LLB N
L1 4
16. VALUE OF CONSTRUCTION: $ 3575.00
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
OWNER INFORMATION .
NAME: ; COMMUNITY SAVANNA;.CLUB JOINT VEN
ADDRESS:
CITY: _ ..RARVATFR STATE: ZIP
PHONE (DAYTIME): -33766---
W-2)9n--3 3 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: N/A
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): )
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: ST. LUCIE COUNTY CERT #: 20286
BUSINESS NAME: JENNINGS MOBILE HOME SETUP, L.L.C.
QUALIFIERS NAME: THOMAS G. ENNING
ADDRESS: 741 A' M('rt . STREEZ
CITY: AUBR STATE: FL ZIP 33823
PHONE (DAYTIME): (3965 — 0883 FAX NO$63 — 967 — 6655 email:
ARCHIT/ENGINEER: r,zr p77UDAD >7'1r�nu�rrnrr rnT..
ADDRESS:
— 2980 SOUTH STREET
CITY: FORT PIERCE STATE: _gj, ZIP 34981
PHONE (DAYTIME): ( 77) — 464— 1S3�7
BONDING COMPANY: N/A
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER: N/A
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.
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: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
OWNER/CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF ST. LIICIE
. The foregoing instrument was acknowledged
b fore met is 23 day, of March 2006 by
who is personally
know me or who produced
as identification.
Signature of Notary
CONTRACTOR SIG&ATURE
STATE OF FLORIDA
COUNTY OF ST, LIICIE
The foregoing instrument was admowledged
before me th,iq 23 day of March , 2�6 by
who is peL
known to me or who has produced
as identification.
Signature of Notary
Jessica Anderson Jessica Anderson
Type or Print Name of Notary e or Print Name of No
��yr v� JESSICA ANDERSON �'P �Y
Commission No. DD494602 (Se 1) �' 0� I,hr coMMIS :Nov. �p� � Commission No. DD494602 (Seal)
,eoril%* P: FS: Nay.
(4071399-0t53 FlOdda No1W 6r3vioa.com
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist. ESSICA
NDERSON
MYCM
-799
Ex -pi Nov.?&2009
orda NotB^rvecom
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