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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBP #: 065 -0221 ZONING: 6 LAND USE: ��� LOT CVG %: TAZ NO.: FLOOD ZONE: FIRM MAP #: 1ST FLR ELV: MAX HGT: CST TYPE: OCCP TYPE: MAX. OCCP: # OF FLRS: p WATER: SEWER: jj 6� CTP II_—� SPRINKLERS STORMWAT LOT OF REC (befr 1/90) LOT OF REC (aftr 1/90) LOT SPLIT LOT SPLIT REQ'D APPRV`D DECAL LIBRARY / PARKS PERMIT NUMBER IMPACT FEE IMPACT FEE FEE REPORT CODE ` PUBLIC BLDG IMPACT FEE HABITABALE AREA RADON FEE c�0 . /Oz� ` (RADON) ROAD (AQII GROSS ROAD I r j C8Q 15'54 CREDIT Y N ` TOTAL ROAD IMPACT ZONE IMPACT FEE IMPACT FEE DUE Y' N SCHOOL CREDIT TOTAL. IMPACT FEE SCHOOL IMPAC T FEE P E FEE �2) C FIRE FEE MISC FEES: TOTAL ui w` POLICE/FIRE/ ? MISC. FEES D�+ ADDITIONAL SPECIFY: �U%?/1�/%'liQ TOTAL ALL PERMITS READ ./ FEES REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE R]WIEVYED BY EXAMINING TURTLE DATE bib 01cy COMPLETE INITIALS *P r, V DATE -FILED - PLAN REVIEW FEE: I Q� • 'O.Dl RECEIPT NO.: � PERNIIT NUMBER: '' O CONCURRENCY FEE: '6 RECEIPT NO:: 14 CERT. CAP. NO.: A MUST BE COMPLETE 8L FILLED IN T BE ACCEPTED ALL INFO O i ST. LUCIE COUNTY PUBLIC WORKS r • _ _ _ _ BUILDING & ZONING DEPARTMENT I 2300 VIRGINIA AVENUE i - 0R1OQ FORT PIERCE, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE I PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: Ll1 SO - y 741 MA -LOOM -D�Z-Lt6F-- 3 tc I F! 2. S/D NAME: MAD. r.t? %SITE PLAN NAME: � r� fx1,�2P2c.s�d C4 3.1 PROPERTY TAX ID #: S - ©© D i 4. LEGAL DESCRIPTION (attach extra sheets if necessary): !m i z)wr4210-bus t A C(Cc� 5.PLAT. 6. PAGE 7. BLOCK .8. LOT BOOK NO. NO. NO. 4-�t)guar ��5 9. PARCEL SIZE: ACRES/SQ FT. `� LOT DIMENSIONS% ZG 4 V 10. DESCRIPTION F F � S O CONSTRU TION� PROJECT OR WORK ACTIVITY: N l9 & i C ly A -RE � o f f 11. SE TBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT SIDE S'/ -� SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ j COMMERCIAL INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 14. Sq. Ft./C-ONSTRUCTION: Z 00 ,egQD15. Sq. Ft. 1st Floor: 2S a i- 16. VALUE OF CONSTRUCTION: $ �&eqe, Did 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 con +try fl n activities. If the value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. Is l n 41. SLCCDV Form No.: 001-02 CERTIFICATION: OWNER INFORMATION: V NAME: �• !✓1V i �%Zt SFLS 1/�G ADDRESS: !a) )S 1k) CITY: �/i').l P rA-iJ 11 t� �,�C�/ STATE: rL ZIP 3L ia �d PHONE (DAYTIME): &2) 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): I ) STATE: ZIP CONTRACTOR INFORMATION ST. of FL REGJCERT #: �[vC� J�f�Co ST. LUCIE COUNTY CERT #: BUSINESS NAME: 1J:LJ2 #,V*) 5rn-0 Gncw 4r,, :ajG QUALIFIERS NAME: ADDRESS: a4&J CITY: 1 `)' S r L I) G C (� STATE: -zip ��i� PHONE (DAYTIME):_ �J� ' 39 SS FAX NO. :27oZ ARCHITIENGINEER: PQU L IAJ LG bF 106 C ADDRESS: I S W ►_ 1 1,r -4160-fz �jT. JU ) i l—r 114 CITY. 6L S T LUG [ .c— STATE: FL ZIP Z� PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: STATE: ZIP MORTGAGE LENDER: .114 01 ^^11 I le" 's �n /%J q ADDRESS: V t , If TT n �j C, CITY: �C-a ► J a n d �.� , STATE: /—L ZIP 5 3 06 0 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-permitsmay-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. ILI OW ER/CONTRACTOR SIGNATURE CONTRACTOR SI ATURE STATE OF FLORIDA COUNTY OF _�Tr L.UftC The foregoing inrument was acknowledged before me this da of , 20y, by2 0-, who i ersonally kno , o me or who has produced as identification. Signature otary Rosemary L. Ritter Commission #DD289829 Type or Print Nari of $'xpires Feb 26, 2008 9 •..•• Q� OF�O•' BondCdTI1iU Atlantic Bonding Notary Public -Tithe Commission Number (seal) STATE OF FLORIDA. COUNTY OF S.4- , e The foregoing jr3strument was ackno ledged e rg e me is� 9 day of �2l� , by 7 �i �Gvho is personally known to me or who s roducedas identification. gnature of Notary � n? Type of Print Name of Notary Notary Public Title Commission 14, eatriz Seirara® At`%`:*= Commission #DD228304 Q Expires: Jul 01, 2007 (seal) '•'�oFFioQ• BondedThrn Atlantic Bonding Co.. Inc NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.