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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY: Q DATE FILED: I U �� r� 6 6-3 PER,�'% �0 � PLAN REVIEW FEE: Q d RECEIPT NO.:NIIT NUMBER: (/ CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: _ ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St. Lucie County Building and Zoning )fie a'j ,'YDG • 2300 Virginia Avenue % pR1pP Ft. Pierce, FL 34982-5652 CeWt"ta4 ZJ r� V 772462-1553���) S J APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION I. LOCATION/SITE ADDRESS: `1 Ji aD`rl ' r t 2. PROJECT NAME: �r�(�Q�-� SITE PLAN NAME: 3. PROPERTY TAX ID #: c�� Io� l� �� � " 0Cn ' I f` 4. LEGAL DESCRIPTION (attach extra sheets if necessary):QD 3t3 �4� Oyyl �- b ' -:� s 114 �k S L[ 14.4k n, n 4 a t J a -w 4- lb Poi . 1 h �ta�,+ ►� 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT-Q 0I CLCff;S_ LOT DIMENSIONS: _ 10. COMPLETE DESCRIPTION OF CONSTRU ION PROJECT OR WORK ACTIVITY: V V tJ t t y.X N- -�70-n ala-0 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL - [ ] COIRCIAL [ 1. INDUSTRIAL OTHER (SPECIFY) 'tC'i7A / �n 13. DESCRIPTION OF PROPOSED USE: 14. SQ. FT OF CONSTRUCTION: 15. SF. FT I st FLOOR: 16. VA UE OF CONSTRUCTION: S +� 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 modif}, 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 F Inm No.: 001-02 E OWI NAMI ADDF CITY: PHON IF TH] FILL I FEE S ADDR CITY: PHON It-161► ST. of BUSIP QUAL ADDR CITY: PHON ARCH ADDR CITY: PHON BONE ADDR CITY: MORI ADDR CITY: IMP( it wit IER INFORMATION ESS: I I I F- i,� e a. STATE: L ZIP: b ( Q0LoC) I E (DAYTIME : as 1 g -1 - 1933 Email: FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE N NAME AND ADDRESS BELOW. [MPLE TITLEHOLDER: ESS: STATE: ZIP: E (DAYTIME): ( ) ITRACTOR INFORMATION 0,&- ayo ` I gaLt FL REG.CERT #: gal ST. LUCIE COUNTY CERT #: FESS NAME:- c-�Ihin JC�.0 c('cyi shcAc- nn =q L. �G-)bS - . ) b Kin f 1� IFIERS'' (NAME: ESS: 7 1() ( L ,' //�� eav\ !c�►t_ �Y oe ZIP: Cl a Wes' .Jp1 e-'g-c e -- STATE: j � ' 1' E (DAYTIME): � � I �1 �1 % FAX NO. `I1a 444 Uq9 I Email: IT/ENGINEER: i - L 1l A S ESS: -- E - " szC -' Q TATE: `tom ZIP: E (DAYTIME): ING COMPANY: ESS: STATE: ZIP: GAGE LENDER: ESS: STATE: ZIP: )RTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification I be voided and returned to you by mail. 0 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 types), swimming pools, fences, walls, signs, screen rooms, utility substations & 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. SIGNATURE STATk YF FLO L � Q CO OF � , The foregoing instrument was acknowledged before me this day of I by The foregoing instrument was acknowledged before me this q+11- day of it C Q A -A 10k/1 , 20�, by who is personally know or has produced who is personally known—J or has produced as identification. , ^ as identification. �Lp D �1n1/ �� `�-�C� Signature of Notary Signature of Notary I 1� SUSM TESTA Commission 1�To. ; i "" f `5eotOMMISSION # DD 664869 Commission No.. , . lob (SeaIPDSAN?ESTA * EXPIRES: April 19, 2011 *.. MY COMMISSION # DD 664669 oQ Bo�edThNMaryPublcUnderwriters ,�;,` EXPIRES: April19,2011 • .P,'f ,f •'¢ o • � &Med 1brU;; ; Public Underyd f� 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. I For specific instructions see appropriate permit checklist. I i OFFICE USE ONLY PP #: ©4/.�• 70�� SECTION O TOWNSHIP '6 RANGE (��� MAP NO. ZONING �" 1 LAND USE LOT CVG %a TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT CONST TYPE Y OCCUP TYPE �i ems• / MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC Before 1/1990 LOT OF REC After 1/1990' LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT CODE HABITABLE AREA RADON FEE PERMIT FEE (RADON) LIBRARY IMPACT FEE PUBLIC BLD IMPACT FEE CORRECTION PUBIC BLD PACT �(GENERAL PARKS IMPACT FEE SCHOOL IMPACT FEE ROAD IMPACT FEE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT DRIVEWAY REQUIRED Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE FEE — SPECIFY SUBS REQUIRED MECHANIC ROOF ELECTRIC GAS PLUMBING NON -CONFORMING LOT OF RECORD FEES MISCELLANEOUS FEES G S DATE SENT TO ADDRESSING: w' ' / REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED Ili, DATE COMPLETED INITIALS