HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - CERT OF CAPACITYOFFICE USE ONLY:
DATE FILED: ,
PLAN REVIEW FEE�
CONCURRENCY FE
RECEIPT NO.: ERMIT NUMBER:
RECEIPT NO.: ERT. CAP. NO.: -
I V
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
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`< St. Lucie County Building and Zoning
2Virginia Avenue �+r
O 10p' FL Pie Pierce, FL 34982-5652 OCi�l�iNA�ltlED
772-462-1553 BY
1004 0;(5I - St Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION ()K-
1. LOCATION/SITE ADDRESS:
2. PROJECT NAME:/71Ctf.S ffff2�- SITE PLAN NAME:
3. PROPERTY TAX ID #: fa OUo4
4. LEGAL DESCRIPTION (attach extra sheets if necessary):'Tftf6 t�2 aF Lot 3
p � schc( L tnr--'Pt-tkZA woo i, Aaogo m4 Tem4a Yu4T Ttf�Rf o� �} RFc: �N
5. PLAT BOOK IF 6. PAGE NO. 15 -1— 7. BLOCK NO. 8. LOT NO.
AI q0 'D. C{O 140 A 150 X 4Cr X
9. PARCEL SIZE (ACRES/SQ FT.): 0 • B'!' LOT DIMENSIONS:_( (0 ' Lb X
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: O
A (Izid -A- D'O 15
11. SETBACKS (ACTUAL) ONT: BACK: RIGHT SIDE: %� LEFT SIDE:
12. TYPE OF CONSTRUCTION (Checkall ropriate boxes ? �t
[ IT/NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION:
16.1 VALUE OF CONSTRUCTION: $ -74 oaa
15. SF. FT 1st FLOOR: V
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to qumfion 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.
Sl.CCDV Form No.: 001-02
l� A
OWNER INFORMATION
NAME: " fiL1Z£4SI}(tk OKASAS �
STATE:
PHONE (DAYTIME): M
ZIP: 342{t (o
s
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): (_)
STATE:
CONTRACTOR INFORMATION i/
ST. of FL REG.CERT #: C4G.15a9 (/ q ST. LUCIE COUNTY CERT #:
ZIP:
BUSINESS NAME: _SLAC.�= 94:9JEJE:C ErttCdfRY �� . t�l G
QUALIFIERS NAME: LiCNL—L 1_- 'bt)M5M -
ADDRESS: 552;5 AC l.L*Ag-C- �otJF='(-
CITY:TW!t �...AINf� LUGV— STATE: Et- ZIP: t?-MCo
PHONE (DAYTIME): dO 6731' G707 FAX NOCjj2j YQ,-6jq l Email: (JpAfrr (_. mtJ�4�
ARCHIT/ENGINEER: AAgUE.0 r--. V-0'r<49SAl f E 320;% l�s
ADDRESS: '7Z06 t=LTG ��{fzGlE
CITY: }'oP��� IJxIC- STATE: jEL' ZIP: 3"9;Z
PHONE (DAYTIME):
BONDING COMPANY: I
i
ADDRESS:
CITY: STATE: ZIP:
MORTGAGE LENDER:
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, 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.
WNE R CON RA SIGNATURE CON AC R SIGNATURE
STATE OF FLOR A STATE OF FLORIDA
COUNTY OF NJ - COUNTY OF S"r l u[ t(a
The foregoing instrument was acknowledged before
me thi
sday of
byt0IG�PIJriYU(/l
who /inks personally known or has produced
11 lL � .I as identification.
Signature of Ngt�rJr
Commission No.yyL}_01z'v,L
The foregoing instrument was acknowledged before
me this tday of �uL, 20 LD_,
by Uytgy1. d : Vutg%:2
who is personally known or has produced
NINA JEWETT
MY COMMISSION # DD&M
EXPIRES June 01, 2014
of
as identification.
(Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERBUILDER, 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 OWNERBUILDER APPLICANTS.
Forspecific instructions see appropriate permit checklist. NINA JEWETT
MY COMMISSION # DD9!
OFFICE USE ONLY BP
SECTION
2�
TOWNSHIP
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RANGE
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MAP NO.
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ZONING
Q�_(.�
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LAND USE
I
KIWI
LOT CVG %
� � �
TAZ NO.
FLOOD ZONE
FIRM MAP #
I� FLR ELV
MAX HOT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
11 �q,�
�.t.�c
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
I( (
AREA ABLE
(RADON)
FE DON
PERFEE
LIBRARY
IMPACT'
FEE
PUBLIC BLD
IMPACTFEE
CORRECTION
PUBIC BL
I
EE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPAC
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC V ROOF ✓
ELECTRIC GAS
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING: _�7 Ion 1fl
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
O
7
INITIALS