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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - CERT OF CAP - ZONING0'729- • O ,-�7-Zs' <. DATE FILED. . ' PLAN REVIEW FEE: b RECEII'TNO.: ' PERMITNUMBER ����• 17a7� SBCTLO -TOWNSHIP - -RANGE - -MAP 110 CONCURRENGY-FE RECEIPT NO CERT. CAP.. NO_: - ZONING L LAND USE LOT CVG% TAZNO_ ALL ST BE COMPLETE & FILLED IN TO BE ACCEPTED FLOOD ZONE \/ FIRM MAP # I "1C 1ST FLR ELV MAX HGT S� Lu C Coun uilding and Z u � �✓ 2300 Virginia Avenue ORI� Ft. Pierce, FL 34982-5652 O C'CG/- C� - CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS — 772-462-1553- SCANNED WATER 1 T- SEWER SPRINKLERS STORMWATER APPLICATION for BUILDING PERMIT St. Lucie County i LOT OF REC 7LOT OF REC (after LOT SPLIT LOT SPLIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE before1190) 90) REQUIRED _ APPROVED PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: So u rf� ki N 6-5 !'fit "u ADMINST LIBRARY PARKS PERMIT � VARIANCE ' IMPACT FEE IMPACT FEE FEE 2. SID NAME: / U114 -7 SITE PLAN NAME: f. /2sT �fDtcR{c �,rst ht eeee REPORT Q PUBLIC BID HABITABLE RADON FEE �]� 3. PROPERTY TAX ID #: pc3/I-L1S13- 600/- pop- 9 CODE V � IMPACT FEE AREA /i' 4. LEGAL DESCRIPTION (attach extra sheets ifnecessary)�/}Tj/j C(f e li eS (RADON) SCHOOL GROSS ROAD Y N - -TOTAL ROAD 5. PLAT 6_ PAGE 7. BLOCK 8. LOT IMPACT FEE IMPACT FEE IMPACT FEE � DUE BOOK a -3 NO- .L/r�,a NO- NO. - SCHOOL CRE Y N TOTAL / ,.OS �^ IMPACT FEE SCHOOL 9. PARCEL SIZE: ACRES/SQ FT. / LOT D SIONS t� 3 o X / / ] O IMPACT FEE POLICE FEE FIRE FEE MISC FEE TOTAL 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY_--X ft / rs / L /7 0 u % POLICE/FIRE -u57 X—rr} L Wi}/2/3Gcr MISC FEES �^ A,. ADDITIONAL -- N - SPECIFY 'E'er C I �, CQ TOTAL N A+ N A5- w A4 PERMITS - - QLU M ©lf-4 of ALL 11_ SETBACKS (ACTUAL) FRONT: �P.CK: RIGHT: pr LEFT: / REQUIRED H tJ NYC_ FEES t r7� 7" - J,, _ SIDE SIDE 9� - 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDTPION Al INTERIOR RENOVATION REVIEWS ZONING ZONING PLANS MISC. VEGETATION SEA TURTLE MANGROVE [ ] RESIDENTIAL COMMERCIAL INDUSTRIAL REVIEWED BY EXAIvIING. Q OTHER (SPECIFY) - �� �Y/1 ST���n-42?/%� /T ©C�'o �y J DATE �8 13. COMPLETE DESCRIPTION OF PROPOSED USE: s v`- 0/9 5r-Xl 13 c�?, o Al C _ INITIALS 14. S. Ft./CONSTRUCTION: �� d ,J p D S q �� � 15. Sq. Ft. 1st Floor: 16_ VALUE OF CONSTRUCTION: $ - / S20 The value of construction is used to determine the amount of pennit fees to be assessed. St. Lucie County lreserves 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 most be submitted with this application. SLCCDV Form No.: 001-02 OWNER INFORMATION NAME:' l� ADDRESS: 9— CITY: STATE: ZIP PHONE (DAYTIME): C��U 6- 7 S S O '7? Y- V& 8- 73 1 cl IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW- i FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: PHONE (DAYTIME): STATE: ZIP CONTRACTOR INFORMATION v ST- of FL REG./CERT #: Cf3 C- b t/ L b 6 D - ST. LUCIE COUNTY CERT #: .14,G 6 9 BUSINESS NAME: i C -:7 A u/ s snit e5 � ;c?! c- QUALIFIERS NAME: C_X f-&1K ADDRESS: I19 257 Y CITYW{2�KPla CN< � / ( STATE: . ?C�C._ ZIP PHONE(DAYTIME): ��/) j?j j -%A o FAXNO. •Z/-,93a,80_5- email: ARCHfT/SNGINEER: /V 0 C- �TLP�2Q,A- — ADDRESS: �55��,//���/� 5/C CITY: ®,qce /ors ec/fi �d Jcf� t�y0 $ PHONE (DAYTIME): (C6t ) 776 - 6 & o BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: � o`te7 STATE: F L ZIP STATE: STA ZIP ZIP 33y/ i 33 v / IWORTANT 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, 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. • trip • � S�� N • C • • • '• The foregoing ins?ment was acknowled ed b fore�r thi °I'rd3y of 1% 20dS by who is personally known to me CONTR41UTOR SIGNATURE STATE OF FLO�IDA COUNTY OF Tk , [_i) G The foregoing ins ment?y acknowled ed �or 1 s�' ayofle ,11, U (CU11L O h' I ya , who is personally known to m S,dtY P „ De:� .:. a•ii: rra Sp(tY P" Debra . Guerra ion # DD258474 Type r:Pnn a �otN" r 14 2007T gr&kQi1Ei3IIt®h4I' '_ p�aonde:: -t• 'rz,rwry_Inc 800186-7019 rF�A' B ndedlroy FON-InsuanCR.im: NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILING PERMIT AS AN OWNER&MI DER, 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.