HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY:
DATE FI�Eb� %% -;I% I I -a,
PLAN REVIEW FtE: RECEIPdO
CONCURRENCY FEE: RECEIPT NO.:
PERMT NUMBER-- 1-kj 1-o;t q�
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
6%�WM Ft. Pierce, FL 34982-5652 %9C'q1V'
772-462-1553
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APPLICATION for BUILDING PERMIT 11�41
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
I p. yj q 5jC4rnA5+-e,' 5+- PROJECT INFORMATION p6L, 3qjY7
I . LOCATION/SITE ADDRESS:
2. PROJECT
SITE PLAN NANIE:
3. PROPERTYTAXID#: 1�7-7--+ 501 064 =oo
4. LEGAL DESCRIPTION (�ttach extra sheets if necessary): �-O+ 61� Tre4!5yre' COL764
5. PLAT BOOK 6 ' PAGE NO 7. BLOCK NO. 8. LOT NO.
A C% e6F
9. PARCEL SIZE (ACRES/SQ FT.): r-, LOT DINIENSION&TA 7-1 IX Z(V�. o')e "3'81'A3'1
5c), a' A 31 C). -I;' /
10. COMPLETE DESCRIPTION OF
OR WORK ACTIVITY:
I SETBACKS (ACTUAL) FRONT1_r20.4 BACK: 12 7. Z' RIGHT SIDE: 'L T SIDE--.
J O\kf\ V:trwp� PA 7) A '
2 '�KtZropriatebox�es� I'UV6 'j wgui,
E OF CONSTRUCTION (Che f, �—�
Fil
-l'-1 NEW CONSTRUCTION EXPANSION/ADDITION fAtERIOR RENOVATION
RESIDENTIAL COMNIERCIAL INDUSTRIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: 'Z;>1rf9t-r- rqmf 1�z r\e�;'1V-k00-f' Ac4r, (kx
14. SQ. FT OF CONSTRUCTION: 15. �17. FT 1stFLOOR-- L
I r —IBM
16. VALUE OF CONSTRUCTION: $ f SO 00 bu
oN Cocr-(ed
F V rc- 61
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 modify the indicated
value of construction if it is demonsuated that the submitted figures are not consistent "dth similar types of construction activities. If the value is$2500 ormore, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02 ar S(
NCk, CUQ 0 U3 �an Cpe— UPDATED 6/25/09
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OWNER INFORMATION
n' r I I
NAME:--r-e%K� a--pj 1--4nV,,k rit-7 I I
ADDRESS: 47700 MOqprjkA 1--)r1'V6 Re (-C,6
CITY:—G . P"'g C-C'e, ' STATE: rk ZIP: ��Mq(
PHONE (DAYTIME): (M 4(00 0 7o (a Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: tk-
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: (- CZ
BUSINESS NAME: Ri
QUALIFIERS NAM�.
ADDRESS: 'FO pay- I
CITY: 44. P'-am'e-
PHONE (DAYTIME): Lllp�-
ARCIEVENGINEER:
ADDRESS: 1 M4 sw
CITY: K 5�- I-UC4.t,
PHONE O)AYTU%4E): (___)
6ONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
Ll-�—
ST. LUCIE COUNTY CERT #: 'SO7 z- f 5-
STATE: f5111 . ZIP: 114 .7 -5-+
FAXNO.172-'fk�r 7".57Email: Ar
I i
STATE: '1� I q, ZIP:
STATE: ZIP:
STATE:
ZIP:
61
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 IM[PROVEiENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU RITEND 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 TFUS 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.
Z
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLOR
,JIM
COUNTY OF
The foregoing instrument was acknowledged before
me this 7,/Vday of 41w,60WA
by An
who is personally known or has produced
—as identification.
A
Si �a � ple- orN oialry ROGER - A. PRIEST
CONTRAC'fOR SIGNATURE V
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this �d?day of &44W&J,:. 20Z
by
who is personally known _ or has produced
as identification.
9 n-4-ie of NotAry
A7-
Novh�ic - state oll FIC
Commission No. My Comm. Expires Nov 7.: irlds Commission No. A. PRIEST
JWA �As Notary Public - State of Florida
Commission # EE 21721
0 *3 MY Comm. Expires Nov 7. 2016
Boom Throw National Notary A., MEW47s? Cc��-ss-orr # EE 217267
mwqp� 1. . 11 1.,
NOTE: TWO (2) S1 I R]EQUIRED. EACH SIGNATURE MUST BE NOTA'"'LUZ& IF AOkft
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO"I
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERIBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #: 12-Al -f-)l L-1
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
X
FIRM MAP
C)t+Qo
I ST FLR ELV
MAX HOT
CONST TYPE
OCCUP TYPE
MAX OCCUP
OF FLRS
WATER
SEWER
I
SPRINKLERS
STORMWATER
I a
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Beforel/1990
After 1/1990
REQUIRED
APPROVED
REPORT
ITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
(RADON)
LI13RARY
PUBLIC BLD
2'20-�6
PUBIC BLD
K) .3w
PARKS
IMPACT
IMPACTFEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
FEE
GENERAL
m0ti r)
SCHOOL
IMPACT
5,qcf5-
ROAD
IMPACT
L4
CREDIT
Y
LAW ENF
IMPACT
FEE
FEE
FEE
12�1 !)I 1
FIRE/EMS
DRIVEWAY
y
1"N
D
DRIVEWAY
-2-
ADMINISTRATIVE
IMPACT
54B
REQUIRED
FEE
I I �mtq
VARIANCE FEE
�
FEE
IK-1
V
15mISCELLANEOUS
SPECIFY
MECHANIC ROOF
NON -CONFORMING
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING-1,7
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
1212)
1;-7-1,3
DATE
COMPLETED
INITIALS
nD 1, q:5 al )( (9�!)