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Home My WebLink AboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY SECTION 13l0 TOWNSHIP RANGE ZONING dI LAND USE 7F, LOT CVG % FLOOD ZONE FIRM MAP # 15T FLR ELV CONSTTYPE - OCCUP TYPE MAX OCCUP WATER SEWER SPRINKLERS LOT OF REC (before 1190 LOT OF REC (after 1190) LOT SPLIT REQUIRED MINST IANCE LIBRARY IMPACTFEE PARKS IMPACTFEE rREPORT E L_�Z PUBLIC BLD IMPACT FEE HABITABLE AREA (RADON) SCHOOL IMPACTFEE - GROSS ROAD IMPACT FEE,, DUE , CREDIT SCHOOL IMPACTFEE CREDIT Y N POLICE FEE FIRE FEE MISC FEE ADDITIONAL PERMITS REQUIRED - Y N SPECIFY Y�orC.i Y' r #: w Y I N MAP NO. TAZ NO. / (� MAX HGT # OF FLRS STORMWATER LOT SPLIT APPROVED FFE RMIT E RADON FEE TOTAL ROAD IMPACTFEE TOTAL SCHOOL TOTAL POLICE/FIRE MISC FEES TOTAL of ALL FEES REVIEWS ZONING ZONING REVIEWED BY PLANS EXAMING MISC. - VEGETATION SEATURTLE MANGROVE 'DATE - COMPLETE INITIALS P �,2 t - t7� . i OFFICE USE ONLY: Jq DATE FILED: �C{ PLAN REVIEW FEE: RECEIPT NO.: 1`P�n PERMIT NUMBER: l f (�L�_ CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED . St. Lucie County Building and Zoning •` 2300 Virginia Avenue F�ORIDP _ Ft. Pierce, FL 34982-5652 - ' -- 0 772462-1553 -r--C(e� Car n��_ccty i 9 APPLICATION for BUILDING PERMI"I pr�-sE CERTIFICATE of CAPACITY/ZONING COMPLIANCE 61-0-) PAC PROJECT INFORMATION 2[fo2 Zruulmg?rL 40VR-T SCANNED I. LOCATION/SITE ADDRESS: BY 2. S/DNAME- NAf2[SovaL RI✓JtIL4 SITE PLAN NAME: St. Lucie County 3. PROPERTY TAX ID #: 14W 3U r (001- 0031 - 0o0 / I{ 4. LEGAL DESCRIPTION (attach extra sheets if necessary): Lo" S - P V 5. PLAT 1 6. PAGE 7. BLOCK .8. LOT BOOK NO. NO- • : NO. 9- PARCEL SIZE: 'AC RES/SQ FT. N /A LOT DIMENSIONS N /A 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: ,eONVLSILC Ipbt=TION OF L=%K7Tltjr'1 u�" POrz-w -ro 11. SETBACKS(ACTUAL) FRONT: NIA BACK: RIGHT:. ;,p LEFT: WOWL le. Wl'TNIt,I SIDE SIDE XISI19r1-1k STtzvttv►Z1f 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) i [ J NEW CONSTRUCTION [ J EXPANSION/ADDITION �] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL L J OTHER (SPECIE]') 13. DESCRIPTION OF PROPOSED USE: FOKL- a 14. Sq. FtJCONSTRUCTION: (O SF .� 15. Sq. Ft. 1st Floor. 110 S� ZO1000.00 , 16. VALUE OF CONSTRUCTION: $ The value of construction is used to detemdnc 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 OWNER INFORMATION NAME: ' ¢ tAtui• RALF (,L--N55Lt_-Jz• ADDRESS: ISf3 TtaN bog NO t Iuny'of CITY: GyK�IENwt ' GC • I'C AM TATE: FL P CC4") M_ ' qqO PHONE (DAYTIME): 2O CO22- SR5e( email: T— IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: MIA ADDRESS: CITY: STA E. P PHONE (DAYTIME): (U CONTRACTOR INFORMATION - Q ST. of FL REG./CERT #: Cg� L03"7'7t�5' ST. LUCIE COUNTY CERT #:y� BUSINESS NAME: Feb WILt3L�C�iWt t W L• QUALIFIERS NAME: pANt L<L 7 - W t L816rL owt j ADDRESS: 10 r_JFN. rl-Al- 04:'LUwN`' SVt7t_F * 22Z CITY: S NIO'r 17 � � . . .. STATE: FL. ZIP S`499 THONE(DAYTIME): e-0 ZZo-ttlbZ FAXNO. 28�1-535? email: K1A 17 LLrLr g LL�u`(. /Ot?�Nrpt_'�CfS. ARCHIT/ENGINEER: � • - .: - '• - ADDRESS: l t8 �►• SttaT2J SO - CITY: S�VlQ` STATE: ZIP 33Hg� PHONE (DAYTIME):( 2$3 3'i9Z BONDINGCOMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: N /A #E_P 4 TAI: ZIP IMPORTANT NOTICE: When a permit is issued and it is nbtpicked up within 60 days after notification it will be voided and returned to you by mail. i 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 ATTA(',YjMENT. OWNER'S AF DAVIT: I c9dify that all the foregoing information is accurate and that all work will be done in compliance th all applicable laws regulating constructio n oning. OWNER/CONTR.kQ.50RS NATURE CONTRACTOR SIGNATURE STATE OF FLOlg4A L uct e STATE OF FLO A `` COUNTY OF t- 4� UCI e, COUNTY OF • The foregoing instrument was acknowledged The foregoing instrument was acknowledged foe a this q{tiay of _A to tt 20p5 by before this � iday of !i I 200by is rbho is personally P�f� who personally kno to me or who has produced known to me or wli has produced h 4, asidentification. ryla as identification. 1 k .. 1 lk" U'6,-Lk of qtary Signature of Nktky =N" M E-5zc,1< — `rNf-0 M E5 � K Type or Print Name of Notary 2'& rwy/'''. Inga Mesick�'° Ar 1 SLommisdm#`DDOSS�a - , t•_ 'eo,,n,.,�1.i�l0.a/n Type or Print Name of Nota` � �.�ppra a,� Inga Mesick CommissionNo.DOp55066n (Sea "L. Q= Commission No-p0 _ � 0,2� f ,O......, � WI YY V i9IF. /�� p��YOJ 1 r11(SQ.. I HM& cm, rm NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUH3NG PERMIT AS AN OWNER/BUILDER, 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.