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Home My WebLink AboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY: BP #: O D Ot0/ OFFICE .USE ONLY SECTION: TOWNSHIP: RANGE: MAP NO.: '-ONING: LAND USE: LOT CVG %: TAZ NO.: =LOOD ZONE: FIRM MAP It: 1ST FLR ELV: MAX HGT: :ST TYPE: OCCP TYPE: MAX. OCCP: ii OF FLRS: 'VATER: SEWER: SPRINKLERS STORMWATE R .OT OF REC (befr 1/90) LOT OF REC (aftr 1/90) LOT SPLIT LOT SPLIT REQ'D - APPRV'D )ECAL LIBRARY - PARKS - PERMIT (UMBER IMPACTFEE IMPACTFEE FEE tEPORT PUBLIC BLDG_ HABITABALE RADON FEE :ODE IMPACT FEE, AREA ,� (RADON) - Y N LOAD GROSS ROAD CREDIT TOTAL ROAD MPACTZONE IMPACTFEE IMPACTFEE DUE :CHOOL CREDIT TOTAL MPACT FEE SCHOOL - : IMPACTFEE 'OUCE FEE FIRE FEE MISC FEES: TOTAL ' POLICElFIRE/ MISC. FEES Y N IDDITIONAL SPECIFY: TOTAL ALL 'ERMITS. ,. - ...... „ . .:.. FEES. . . . .. .. ... tEQ'D - HI YiU0 t.rA fV717,f \4 - = cca 13,ma t xnoo REVIEWS ..... ...... ZONING,..„„ a, ZONING PLANS of , VEGETATION SEA MANGROVE AT&W � .M AIDISiTAq REVIEWED BY EXAMINING RS . xa -J" bc�s ' ; l'l)RTLE )ATE ono. s .m• -- 'a%... i.. ............... e DATE FILED: 4 OLO PLAN REVIEW FEE: O RECEIPT NO.: PERMIT NUMBER: Q ( off Grp I - CONCURRENCY FEE: RECEIPT NO.: CERT. CAP'. NO.: ALL INFO MUST BE COMPLETE 8t FILLED IN TO BE ACCEPTED ST. LUCIE COUNTY PUBLIC WORKS Fle BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE 20R1�P .FORT PIERCE, FL34982-5652 SCANNED 561-462-1553 BY St. Lucie County APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT. INFORMATION -Oj" (Q 1. LOCATION/SITEADDRESS:' A E ZL P— r L i4ms 2. SID NAME: 17 C/If�UC� PLAN NAME: .�/n1n/ 3. i p PROPERTY TAX ID 1 3RI5--R01-0017 nnSITTE�E I W-0 4. LEGAL. DESCRIPTION (attach extra sheets if necessary): LO-T 10, OF fir-Ro lit eg ficeI malo Twe PLfFTT►TER&(jF "r4>1N RAT Bnd l A-199654144A /1FTF1�Puacre�ae�, OF3xt�,erF��larY,FLA 5. PLAT 6. PAGE BOOK NO. BLOCK / NO. � S. LOT NO.- 9. PARCEL 350 SIZE: ACRES/SQ FT. LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTNITY: 3 jkM1% ..yL1(1d K 11 12. 16. SETBACKS (ACTUAL) FRONT: BACK: / 9/RIGHT --V-�L-L Q SIDE TYPE OF NSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSIOWADDITIO ] RESIDENTIAL [ j COMMERCIAL OTHER (SPECIFY) - DESCRIPTION OF PROPOSED USE: "If LEFT CU SIDE: (7 N [ ] INTERIOR RENOVATION [ ] INDUSTRIAL Sq. FtJCONSTRUCTION: '� 15. Sq. Ft.1st Fioor: VA LUE OF CONSTRUCTION: $ aGl�l/ -_ The value of construction is used to determine the amount of Mug fees to be assessed. St. Lucie Canty Mservoa the dOt to question and/or molly the '-hamtsd value Of construction if It Is demonstrated that the submitted Bpmes are not OW1814tent with s rMw types of construction sctlW9es. H the value is S25M Or more, a RECORDED "oo of Cammencement nmt be wbnNtted with Oft appticetiam - - LCCDV Form No.: 00i-02 WNER INFORMATION: 4ME: )DRESS: TY: MDVT c�) 1, Luo,=_6 STATE: _ FL ZIP 3 � 10NE (DAYTIME): .. . THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS :LOW. f :E SIMPLE TITLEHOLDER: )DRESS: TY: LONE (DAYTIME): JNTRACTOR INFORMATION of FL REGJCERT 0:� /� '�� C ISINESS NAME: A, -*a Noe IALIFIERS NAME: -Q-K, ]DRESS: 410 rY:. 'rk bL :ONEtDAYTIME): i222LS :CHIT/ENGINEER: DRESS: Y: ONE (DAYTIME): LADING COMPANY: DRESS: Y: RTGAGE LENDER: DRESS: Y: STATE: ST. LUCIE COUNTY CERT #: ZIP CERTIFICATION: This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate c capacity, if applicable, for the permitted work. 1 certify that no work or installation has commenced prior to the issuance of a permi and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand tha 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 racirien4i�l i�o • NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYINC 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, ANC INTEREST THAT IS SUBJECT TO ATTACHMENT AS A CONDITION OF THIS PERMIT YOL 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.. . K0_En" - STATE: /�. /ZInP�/" ' /�1&22 OWN CONTRACTOR SIGNATURE FAX NO. - ! /� STATE OF FLORIDA COUNTY OF STATE: ZIP 1 ) A) 6- ' STATE: ZIP STATE: ZIP The foregoing instrument was acknowled ed before me this day of C` a(G,NOgto, by ,. )n+k . or who has produced �i h: �c as didentification. ��— " -4uo za�n Signature of Notary Type or Print Name of Notary Notary Public Title. ........................................ PATRICIA M. GIUNTA ,�� p-� ConunsOGosoSeo7 �� mmission N EWW vmrm,o c 8W4@dVW (W0M2.4Z4: (seal) ° "dF Fww, r'°•w A...;:!°0...i Uw �y CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged )qefore me this'��day of 20 Ot , by c rv�vid�efo is personally known o o� Signature of Notary Type of Print Name of Notary pDO�� mission Number•••••••••••« �•••. PATRICIA M. GIUNTA NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IPORTANT NOTICE: When a permit is issued and it Is not picked up within Sd days IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEF;VBUILDER THE OWNER MUST PERSONALLY APPEAF ter notification it will be voided and returned to you by mall. TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.