HomeMy WebLinkAboutBUILDING PERMIT APPLICATION` IOFTICE USE ONLY
SF,C,TION 1 t TOWNSHIP
ZOATING-A LAND USE l
FLOOD ZONE
CONST TYPE
VFATER
LOT OF REC
BePare 1/1990
REPORT
CODE
LIBRARY
BWACT
FEE
FIRM MAP # I 1
OCCUP TYPE
RANGE
L
G%
Iff FLRELV 50
MAX OCCUP
SEWER `�� I SPMUM
LOT OF REC LOT SPLIT
After 111990 REQUIRED
L.�L.� HABTTABLfi RADON
AREA"' r (RADON) _ �
PUBLIC BID UBIC BLD
BRACT FEE IMPACT
mun _V77n FEE
SCHOOL
ROAD
CREDIT
BWACT
BRACT
FEE
FEE
FEE/EM[S
DRIVEWAY
Y
N
DRIVEWAY
IMPACT
REQUIRED
FEE
FEE
SPECIFY
MECHANIC 1,f ROOF v
NON -CONFORMING
SUBS
ELECTRIC 1/ GAS
LOT OF RECORD
REQUIRED
PLUMBING _V_
FEES
DATE SENT TO ADDRESSING
Y I N
MAPNO. I'
TAZ NO.
MAX HGT
# OF FLRS
STORMWATER
LOT SPLIT
APPROVED
PERMTr
FEE
PARKS
IMPACT
FEE
LAW ENF
BRACT
FEE
ADAM41STRA.TNE
VARIANCE FEE
MISCELLANEOUS
FEES
.REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTTE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED ! %�
OFFICE USE O
DATE FILED: �� I
PLAN REVIEW FEE: D_ •a�CEIPT NO.: �� _P RMITNUMBEI
—CONC-URRENC-Y-FEE. CETPT NO.: CERT. CAP. NO.:
ALL INFO MIDST BE COMPLETE & FILLED IN TO BE ACCEPTED
LANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue _
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT `(
-CERTIFICATE of CAPACITY/ZONING CO PLIANCE
PROJECT INFORIVIATION �, y
1, LOCATION/SITE ADDRESS: oS .�.� P it /P/'_C
2. PROJECT NAME: LjES'F6EP / 965 SITE PLAN NAME: "-
3. PROPERTY TAX ID #:�n
L 4. LEGAL DESCRIPTION (attach extra sheets if necessary): liLL D'1 is 1 " 3 ae
1�,� � L'JdAS ` h1 Yre&e
5. PLAT BOOK It) 6. PA N�h-10 7. BLOCK NO. (0 8. LOT NO.
7 �
9. - PARCEL SIZE (ACRE!/SQ FT.): I LOT DIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: /���r7►cn */0
f',[rS'�Pn R �.�I�>nZP '] JJc�LifO:)rliS 1�r Pi, YA IIAo (_AA 'Vi z, I
it.
12.
13.
SETBACKS (ACTUAL) FRONT BACK:RIGHT SIDE:. LEFT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ANEW CONSTRUCTION EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[I(] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE: /e r-4Pnt Jy Pes
14. SQ. FT OF CONSTRUCTION: 57 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $ S& 006
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
r(c cosT $ 'so►
UPDATED 6/25/09
�A
OWNER INFORMATION
NAME: Tpe�pp� We.SI eff
ADDRESS: 105- 5• C.c1/c1r;%40J rL
CITY: R O'I'_rce F STATE: F-1-
PHONE (DAYTIME):- =_2 061-- (, 746 Email:
ZIP: 3 L[ L j
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 #: ST. LUCIE COUNTY CERT #:���
BUSINESSNANYIE: �e(1, e CeA rrtr.4rru Sye . -/-,IC.
QUALIFIERS NAME: 04cit- jC/yJII
ADDRESS:
CITY:ye`v )Uto STATE: (' L ZIP:
PHONE (DAYTIME): %6•- a%,2 FAX NO. 'Z 7a -46 L/--101 Email: oIF
cG! �, fC, rIGS 9'1'biY(
ARCHIT/ENGINEER: The 5 1-l" r-- er (r-,4Z7
ADDRESS: —76 Sri C1I r I°Se C'6 t/
CITY: _54w<'-f
PHONE (DAYTIME): 7 7 oZ �O - LiCy
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER: V
ADDRESS:
CITY:
ATE: FL ZIP: 5 C( -/ 9 7
STATE:
STATE:
ZIP:
MOO
DIPORTANT 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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
-structures (all type§); -swimming pools, fences, walls, -signs, screen rooms, utility substations &c accessory uses to another non-
residential use.
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
r^
O R OR CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FL M_�
��COUNTY OF
The foregoing instrument was
cknowledged before
me this day of 20—Li_,
by
wh is personally kno or has produced
Commission
ANGELA M. HUFF
. EXPIRES: April 12
Bonded Thru Notary Public
STATE OF FLORIDA COUNTY OF � P
�S-� L
The foregoing instrument was acknowledged before
me this v `� l day off 20 1� ,
by Ea��
who 's personally kno or has produced
as identification.
Signature of o
ANGEU M. HUFF
Commission No`
• _ a th4a�'? MY COMMI
XPINES�25
Bonded ThruNary
Public Underwri►em
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.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.