HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE QN,LY
SECTION
TOWNSHIP
RANGE
-MAP-NO.
ZONING
LAND USE
LOT CVG %
So/I
NO.
` C). 0
FLOOD ZONE
FIRM MAP #
1
1ST FLR ELV
I
MAX HGT
CONST TYPE
OCCUP TYPE
_
_MAX_OCCUP -
# OY ELRS
WATER
SEWER
SPRINKLERS
STORMWATER .
LOT OF REC
LOT OF REC (after
LOT SPLIT
LOT SPLIT
(before 1/90)
1/90
REQUIRED
APPROVED
,�� lw ryl,Y li Nj( �l"lvC
,\
'S35r�YC; �`-,..� rLa dS�.a
'F9 .,x ;r a' i a
l3; 4 �S 1"'h., 3 3't .;�. Yt ?LNtl?.
y �� '� ='�
,>.- 'ei _. G)th+�, ."..'1
c i
"4 4,�. t <
-'� ,xt N}�• X �.c
m.?9.'''R'�• .�C 4ya-t-i,
t °`''+i•••.ia7%-i^�Fa.�'�i!
+5.+� Y,i ..r ,2..�.
'Sr jt _ j J='.'.
a _
.,§y, �`"'° t� ,s'L 1 -'
e�
3.
¢
y�
.... ....v.s
-
C
ADMINST
LIBRARY
PARKS
✓
PERMIT
VARIANCE
IMPACT FEE
IMPACT FE
FEE
REPORT
CODE
PUBLIC BLD
IMPACT FEE
ao
RADON FE�
/
,
)
SCHOOL
rYlCU Y-,
GROSS ROAD
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
IMPACT FEE
IMPACT FEE
DUE
SCHOOL
C T
Y
Nor
TOTAL
IMPACT FEE
p `? �� Y
" F
5 F 3
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
d V
POLICENIRE
MISC FEES
ADDITIONAL Y
N
SPECIFY
CL 0c 7
TOTAL
PERMITS
of ALL
REQUIRED /
/Zeo %I—'-
FEES
d iL = .tom T
7j>r
", �- rrc {.;-,_..�. ..+^,.. .._._.,cam ... ♦..... Y=.s
.. n'.��nrt._ c Ga...'.is,3: i.... .,a Ih:..
SZ <^L.``s�s !' .w.1•T'c_ �^ry u "3:5. "��.' (S ti�4t. .'3.-...:,F�✓7,.'�r'
i.� 5
REVIEWS
ZONING .
ZONING
PLANS
MISC._•
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMING
DATE
COMPLETE
�y
INITIALS
.OFFICE USE ONLY: '
DATE FILED: I I J OLD
PLAN REVIEW F"" - RECEIPT NO.: PERMIT NUMBER: C)(-o(_�B
----CONCURRENCY-FEE REC-EIP--T NO.: -- --CERT-C-AP.-NO: - - - —
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
coGy�.
`' St. Lucie County --Building and Zoning - _mi,(�o
2300 Virginia Avenue
�ORI�P- Ft. Pierce, FL 34982-5652_ �l\ 1SSL(Q
} - -- - - — -- 7-72-462-1553- ---
NA 01.00q - CV &35
�-(rl 1n'1l�cS-� b2- i5S C.c-2 C'S Ic
!' APPLICATION for BUILDING PERMIT- CO -A
CERTIFICATE of CAPACITY/ZONING COMPLIANCE.,'s C^
1. LOCATION/SITE ADDRESS
2. S/D NAME: ti� va in►vl_ ,
PROJECT INFORMATION
i 0.%1ea HaWk Der - , Po e� -1-S+ . Luci'e
SITE PLAN NAME:
SCANNED
BY
St Lucie County
FL 3LIC192
3. PROPERTY TAX ID #: 3I 2-14 - 7 0 3 s o Ogg -^ 000 -q
4. LEGAL DESCRIPTION (attach extra sheets if necessary): j lie- ra i Y W O( -V S 0-+ QS t yan nag,
Club B[k . •70 Lc)--f— [
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK 1p NO. �3 a�. NO. % NO.
9. PARCEL SIZE: ACRES/SQ FT. .po LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
✓ t -I ✓ ✓ I
11. SETBACKS (ACTUAL) FRONT: f BACK: 1 RIGHT: ( LEFT:
I_
SIDE SIDE l�®
E 12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
I [ NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: 7RES
14. Sq. Ft./CONSTRUCTION: 06 S�' 15. Sq. Ft. 1st Floor:
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 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. �Crp . / ,S Oo%'/ p?S O 1`=�•'...�
SLCCDV Form No.: 001-02 Cj� /Z 4 i; ` elVOA16 = 7 0 �GD- -''
iS V
1�-
CERTIFICATION:
OWNER INFORMATION
NAME: 0_8rn1 u1g i+y _ a�cthh OL CiUb o n+ �/-entU rye c o
ADDRESS: ?t �O. EVx �S9
CITY: CAea(OQAZr-STATE: FL✓ ZIP .�-,�
PHONE (DAYTIME):-i1= - _%:D9— 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:
ADDRESS:
CITY:
PHONE (DAYTIME): (
CONTRACTOR INFORMATION
STATE:
ZIP
ST. of FL REG./CERT #: 12i20O u-7 3(o _ ST. LUCIE COUNTY CERT #: - 1 � 20
BUSINESS NAME: aL))-�h r—lo ID, ALUh1,inUm Prod VCS j [nc
QUALIFIERS NAME: (�a,,nj K • Wh j4 )aino
ADDRESS: L. 9() 1
CITY: Or-i P! rc e STATE: ZIP�Cl �2
PHONE (DAYTIME): ('I72)4 U :: D 9 l FAX NO. `7"7 2-4 (a !? —V G 13 email:
ARCHIT/BNGINEER: LGLw r-en ce t3eGnn-e-1-'�
ADDRESS: PO edg 214.31nf
CITY:6.. Dft L; f'Ol'1 %_ STATE: ZIP 3 Z l 2 l
PHONE (DAYTIME): (' $W -1(P - I•F �J -
BONDING COMPANY:
ADDRESS:
CITY: STATE:
MORTGAGE LENDER:
ADDRESS --
CITY: 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.
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 AFF AVI I certify that all the foregoing information is accurate an 1 compliance
With all applicable laws regulating construction a on _
CTOR SIGNATURE OR SIGNATURE
STATE OF FLORIDA '
COUNTY OF
The foregoing iiRtrument was ac owledged
be ore me this day of 20�p, by
who is peronally
known to m or who s produced
as identification.
Signature of Notary
Type or Print Name of Notary
Commission No. (Seal)
CHRISTINA BROWN COUNTY OF
Notary Public, State of Florida
My comm. Expires Feb. 17, 200P
No. DD39777S The foregoing instrument was acknowledged
efore me this 6 day of � 20LAg by
T , who i person' ly
known th me or Ao has produced
as identification.
CHRISTINA BROWN Signature of
Notary Public, State of Florida Notary
My comm. Expires Feb*
17, 2009
No. DD397778 f��� -1 �„✓1
Type or Print Name of Notary
Commission•No. (Seal)
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.