HomeMy WebLinkAboutBUILDING PERMIT APPLICATION6 1� --Vo
OFFICE USE ONLY:
DATEIFILED:
PLAN REVIEW FEE:
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RECEIPT N,_
PERMIT NUMBER:
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ST. LUCIE COUNTY PUBLIC WORKS �,�CD l ���►ill
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
2OR10a FORT PIERCE, FL 34982-5652 tl
561462-1553
I a St. SCBYNED
APPLICATION for BUILDING PERMIT Lucie County
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
V n Q PI IROJECT INFORMATION �j " - p �[�
1. LOCATION/SITE ADDRESS: 9 O `c C . Cbl e IZ [ o Zd � 54 1 I uJ
2. S/D NAME: iJ I A - I}' Jcs + 13t>, rrY SITE PLAN NAME: PeaN
3. PROPERTY TAKID #: o73 D - 333- 0 00 0 00 1
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 1 �-� 4- /.�, r -
71'`^S !' A -A ,O ! / 0'�t� - �ye.k V L.e.Y e� -Y r �ri Le. C7 ^Y l .0-ey-hw nC-0—ryLQ-rj G
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. Ai IF NO. n/T NO. Al' A-
i
9. PARCEL SIZE: ACRES/SQ FT. �' LOT DIMENSIONS 41r) rX a a5 r Y- NY r X 'q S-
/S 30 P Y .7 3 r - Gtiu
10. IDESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: ,3.5 BACK: IGH �� LEFT
SIDE ,, SIDE: / ,4 3 . S
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[� NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: kp-5 � I tl- -e'
14. Sq. Ft./CONSTRUCTION: / 9 [3 15. Sq. Ft. 1st Floor. 13
16. VALUE OF CONSTRUCTION: $1 g6)) O Q5
The value of construction is used to determine the amount of permit fees to Wassessed. St. Lucia 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
THE AVERAGE PROCESSING TIME FOR MOST BUILDING --'MITS IS TEP:'(70) WORKING DAYS
OWNER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
Rari, STATE: I ZIP
Iati Ll"- 7 7ss-
3�9y�
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: A( f a
ADDRESS: /1I ra
44
CITY: 7\I 1 )a STATE: ZIP
PHONE (DAYTIME): ( 1 \ %� y 14
CONTRACTOR INFORMATION
ST. of FL REGJCERT #: 12'A opt, Io rY' (o R� ST. LUCIE COUNTY CERT #: , i � BLS• I. ,'
BUSINESS NAME:- 14-6-yYLa F CJ] I« o
I
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
„^--o.,,, Lo STATE: -= ZIP
(X&1 33� 3t,9 FAXNO._ n, 1-33(<,-9 /L%k
-3
ARCWIENGINEER: ra.(A-1 WP..7 P_.GI
,.ADDRESS: /_9' S-q �V\I, p �I �0,-e- CITY: (aj �- C75 ,'Ucze- STATE: tT- ZIP
PHONE (DAYTIME): (S(c h '% S s--9 8 91� -
BONDING COMPANY:. 1I I ✓-4-
ADDRESS: A) I ✓a -
CITY: I ✓a' STATE:' A) ZIP a
MORTGAGE LENDER: M, of " &)a -in d- te• a1yt ac-✓+yC.Lc.Ly lv rV I Q �l�Sn 01
ADDRESS: _ 02 i d D /i/lOI2 �3'f% I I d( GY.v� O Q'.�,
CITY: ����(�t'[Lk�-..z2_ ' STATE: C;Ip 7JP
IMPORTANT NOTICE: When a permit is issued and it is not. picked up within 610 days
after notification it will be voided and returned to you by mail.
CERTII
j This applicati
capacity, if ap;
and that all wl
separate pent
> TANKS, AND
CATION:
on is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of
3licable, for the permitted work I certify that no work or installation has commenced prior to the issuance of a permit
)rk will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that
tits may be required for -ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,
AIR CONDITIONERS, ETC., not otherwise included with this building permit applicatidn.
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.
it
OWNER/CONTRACTOR IGNATURE
STATE OF FLORIDA
COUNTY OF 6— UciP,
The foregoing instrument was acknowledged
before me this _day of _Mea-_, 202° , by _
• a ; who is ersonally known to me or who
/as�roduced_ as identification.
CONT CT SIGNATURE
STATE OF FLORIDA COUNTY OF Z%LAXt. L
The foregoing irTstrument was acknowledged
before me this day of MMW , 20J by
kCLA•v who is person Ily`known to me
or who nnhas produced _04'_ as identification.-
Si nature of Notary �o CHERYLIYNN BLUE Signature of Nota
P+CO,OiMISSION # CC615817 n y� i1 LISAANN FRY-
✓,� h EXPIRES A4AR 22, 200, L W� �»n }� 7t My Cemmk-sbn C05529M
*� ��'''AmANR(4ONoED Wo co INC. Type of Print Nam of Notarlr4 e E"°4� May.18,2aoo-
Type or Pnnt Name of Notary yp t-:
(seal)
Title Notary Public Title
C VSxa9b`6 ."
ion Number Commission Number
(seal)
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 APPEAF
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
BP #:
SECTION: TOWNSHIP: 2� RANGE: MAP NO.:
ZONING: nn LAND USE: •nnJ • a S LOT CVG %: TAZ NO.: ✓v'
FLOOD ZONE: /7(! FIRM MAP #: 1ST FUR ELV: MAX HGT:
CST TYPE: TE OCCP TYPE: il
MAX. OCCP: # OF FLRS:
WATER:/ _ ] SEWER: (OSPRINKLERS STORMWATE
( (/ / /��/ �R
LOT OF REC (befr 1/90) LOT OF REC (aftr 1/90) LOT SPLIT / "'/� t LOT SPLIT
REQ'D APPRV'D
DECAL LIBRARY //�' PARKS n PERMIT
NUMBER IMPACT FEI* ' I IMPACT FEEA FEE
REPORT PUBLIC BLDG ''�,; HABITABALE RADON FEE
CODE 1D� - IMPACT FEE AREA ---1, *'
(i (RADON) I •l'
Y N
ROAD I/� GROSS ROAD CREDIT TOTAL ROAD
IMPACTZONE III / IMPACT FEE / IMPACT, FEE
DUE J
SCHOOL ^ CREDIT -
IMPACT FEE VM/� TOTAL '
�. SCHOOL
IMPACT FEE
POLICE FEE / FIRE FEE MISC FEES: TOTAL 09
POLICE/FIRE/
MISC. FEES
Y N
ADDITIONAL SPECIFY: TOTAL ALL
PERMITS FEES
REQ'D
REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE
REVIEWED BY EXAMINING TURTLE
DATE
COMPLETE
INITIALS }�(�