HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSBP #: b�D 103�
SECTIOI4:
TOWNSHIP:
�� RANGE:.
MAP NO.:
ZONING:
P 1 1 T'1 LAND USE:
Ill
1'
' o LOT CVG %: Liu
l� -!
TAZ NO.:
FLOOD ZONE:
/
7t FIRM MAP
/ \
S r•
I
1ST FLR ELV:_ ,
MAX HGT:
z /
�.J
CST TYPE
. OCCP TYPE:
MAX- OCCP:
it OF FLRS:
.
WATER:
n r SEWER:
F R L
.SPRINKLERS
R ORMWATE
LOT OF REC (be fr
1I/-90)Y
LOT OF REC (aftr 1190) -
LOT SPUT
LOT SPLIT
REQ'D -
APPRV'D
Fnon$116
O`
KS
IMPACT
u OD
(�
ERMIT
PFEE
NUMBER
IMPALIBRARY CTFEE
FEE
{ •
j REPORT
PUBLICBLDGe
r,
�y7.34
HABITABALE
RADON FE
76
1 CODE
I /c� 1
- IMPACT FEE !
�i
AREA
(RADON)
I-nCk1 V)
Y
N
ROAD
GROSSROAD
CREDIT
TOTAL ROAD, -
IMPACT ZONE
IMPACT FEE
IMPACT FEE
I
DUE
_
...
: Y.
N.
SCHOOL-
CREDIT
_�- X r - - -
t' *« `'`'K,.--�'�%, s
Tg7AL
'
IMPACTFEE
/
--" -- _
.,�- ys`e.,�w
'
SCHOOLON
IMPACT FEE
.
51a5,
/
w
.
-
-
- ♦
1w
bJ
POLICE FEE
�
FIRE FEE
�
MISC FEES::O Y
_
_'�� • � ' �. � I • •' �
.5
TOTAL
S.,
ADDITIONAL
PERMITS
SPECIFY:
7Gt11Yf'(�j���
TOTALALL
FEES
rJ
VZ\ONING
/.
REQ'D.
✓�' C'
REVIEWS
ZONING -
PLANS.,
]
' VEGETATION
SEA
MANGROVE
. REVIEWED BY
EXAMINING
///L (%E
TURTLE
aI5ID�.5/b
3bT
lSf�9�
oM LETE
vim'
INITIALS
DATE FILED: p
PLAN REVIEW FEE: �0 • 0 • RECEIPT NO.: 5VRTd / PERMIT NUMBER
..��rrnooverry r==e. /�C-'A--�l ocreeoT ern - f'FTY r ('AP Win -
ALL INFO T lST BE COMPLETE 8z FILLED INTO BE ACCEPTED
��e cow ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE - - - X�eb -
ORLOQ' FORT PIERCE, FL 34989-5652.
772462-1553 -
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIA TiTANNED
BY
PROJECT INFORMATION St. Lucie County
1. LOCATION/SITE ADDRESS: g4a-I windr-4+ C►mle n Ff Y i\ewe, 3CH11 S'
2. SID NAME: RQlm 8ree7-e5 Club SITE PLAN NAME: Valor greemes Club
3. PROPERTY TAX ID#: a3107500-0OQ4. 000- 7
4. LEGAL DESCRIPTION (attach extra sheets if necessary): LOT j 13je K_ 1 ?-4M ?)reeZerJ -
C bL n± Beek 44.%es 3a-35 of 4he ?661ic Records 4.S}, Luc►eCounty.
5. PLAT. 6. PAGE- - 7. BLOCK 8. LOT
BOOK 9 2-3 NO. NO. _
9. PARCEL SIZE: ACRES/SQ FT. 3 %45 "T LOT DIMENSIONS 401, X 4 (9,
3 6 y l) ,
10.1, DESCRIPTION OF CONSTRUCTION PROJECT OR WORKACTIV-IITY:
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT
SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION
RESIDENTIAL
[ ] OTHER (SPECIFY)
[ ] EXPANSION/ADDITION
[ j COMMERCIAL
( 11 % LEFT
SIDE: ' 01
[ ] INTERIOR RENOVATION
[ j INDUSTRIAL
13. DESCRIPTION OF PROPOSED USE- S'IY%ale 11111Al V re S O nc e- 31 9 .'
14. Sq. FLICONSTRUCTION: 1359 15.. Sq. Ft. 1st' Floor 14-7 b
16. VALUE OF CONSTRUCTION: $ i S
The valve of construction is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the right to question and/or mocW the
irhdicated value of conshuctimif it is demonstrated .that the wAmit7ed Njum are not cc i%istentwth similar types of m bucton activities.- If the value hs 32500
or more. a RECORDED Notice of Commencement must be submitted with this apptlmtom ..
U U
A
. i
SLCCDV Form No.: 001-02 "
OWNERI. +
NAME: CeY,�eX �IJYCi S �+
�301 QUUIrt4'uw► $lud 1 hoar �og R� stE:aDO
ADDRESS: 8198 _ ... i
CITY: _ LEVY►-[1OY1BeQC� STATE: I. 1 ZIPS
PHONE(DAYTIME): 1Wli 53�� OOO
.IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: ,
ADDRESS:
CRY: STATE: ZIP
PHONE (DAYTIME):
N
CONTRACTOR INFORMATION Q
ST, o1 FL REGJCERT#: C&CO5 21
BUSINESS NAME: /0 ,
QUALIFIERS NAME: IN) V I � . /1
ADDRESS:
CITY: 1BM1y►+bM B
PHONE (DAYTIME): f51511 S?16- t IW
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER -
ADDRESS:
ST_ LUCIE COUNTY CERT #: -- - -kivo
�
st
STATE: i v ". ZIP 334 2�
FAX NO- 561- 5564n D
DP 5 �
ZIP "
CITY: . STATE ZIP. .
4W106it,TANT. TLOTICE:•1Nhen•a permit is" issued and it is, not=picked up with➢n 60 days
after notification it will be voided and iretui-66d 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-1 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 otherwiseincluded 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 FORTHIS 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 nd zoning-
OWNE CO RACTOR SIGNATURE R SIGNATURE
STATE OF FL¢Qj��IDA STATE OF FL RIDA
COUNTY OF Ya I teia_. COUNTY OF /1_9r�r rye
The foregoing" instrument was acknowledged The foregoing instrument was acknowledged
" before me this 17 day of ta.. 204, by _ before me this � day of V2L . 20 06 by
®ai�C vho is personally known to me or who` paved Abram§ who is personal) known to me
has produced as. identification. or who has produced as identification.
NOTARY PI7BIIC,SGITE Op 1'LMN
ignalure of NotaryotpaY PO,` RBbeCCa Miller sign u of Notary Jennifer Aillttin
: Commission # DD362076 COMMISSI011 #DD371821.
(Y Expires December 27, 2008 *Explm NOIZ 15, 2008
Type or Print Name o ynanewnrm/rnm mws e, N eca�701a Type of Print Name of Notaqunded Thn Atlantic Bonding
Notary Public Title Nolary Public Title
Commission -Number Commission Number
(seal) (seal).
NOTE: TWO (2) SIGNATURES ARE REQUIRED_ EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPI=AR
TO SIGN THIS APPLICATION 114 THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION-
01c)v - 0r'550
_9R
DATE FILED_
BP#.
PLAN REVIEW FEE: RECEIPT NO-: PERlyl7TN-(II--MFR= O-1 6[- 3`-D
CONCURRENCY FEE: RECEIPT NO_: CERT. CAP_ NO_:
ALL l MUST CO PL
TEsl���.TOACCF_�EU
-N
�4
yS a�
:.
SCANNED
J��e coG
ST_ LUCIE COUNTY PUBLIC WORKS BY
7owNSHIP:
RANGE: MAP
-
h Cy_ BUILDING & ZONING DEPARTMENT St, Lucie CountySECTION:
230D VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
-
LAND USE.
LOT CVG %: TAZ
NO.:
772-462-1553
ZONING:
}-�y 'y
APPLICATION for BTIMANG PIEMWIT
'1 ELV:_ MAX HGT:
FLOOD20NE:
FIRM MAP 4:.
ST FLR
CERTMICATE Of CA PACZZ'WONXNG COM[PLI NCE
CS7 TYPE:
OCCPTYPE:
MAK OCCP
4 OF FURS:
-
PROJECT INFORMATION
I � _
'1_ q4g �1�
SEWER:
SPRINHLERS
STORtvPNATE
LOCAT)ON(SITE ADDRESS: ` w 1
WATER:
R
{/
2. SID NAME: VQ63 3CE Z 1...�LX6 SITE PLAN NAME-- q4m . ` p- P_�.`ab
LOT OF REC (Deft 1190)
LOT OF REC (aftr 1/90)
LOT SPLIT
-
LOT SPLIT
APPRVD
3_ PROPERTY TAX lDiI_ 61,00' OO�1•� C�:�i •-I -
REO'D
4. LEGAL DESCRIPTION (attach {�.
"Ira sheets ifneceesary): 4 D 1310. m F)fee7_�5
' DECAL
NUMBER
LISRARI(
IMCT
PAFEE
PARRS—P-ERMIT
IMPACT FEE' - FEE
("'�
iy k .q Ci
C]�L4—=. rtis /'Do tomes. 3D-35 o-F 4_1-Le e Recora!s 4St. LucteeoLLrt'4'y.
_
_
� REPORT
PUBUC BLDG
HABITABALE _
RADON FEE
'
5. PLAT- 6_ PAGE- - 7. BLOCK - B. LOT
CODE
•IMPACT FEE
AREA
BOOK L� 9 NO. 2 -3 NO-
(RADorq
1 No.
-
Y N
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACT FEE
9- PARCEL SIZE: ACRES/SO FT. 3$ LOT DIMENSIONS g0 Y-4b
IMPACT ZONE
IMPACT FEE
DUE
14. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY-
µ
SCHOOL'
CREDIT
z sr ,,,.,y. ,_,;.
TOTAL
- IMPACT FEE
'- ,a- `^`�,'=^ati'�'-
SCHOOL
-
•=Y
�= =a ,- k w•: z- --•
PACT FEE IM
�
11: SETBACKS (ACTUAL) FRONT_ BACK RIGHT LEFT
l� �i • (D SIDE (e SIDE �(J'
POLICE FEE
FlRE FEE ".
MISC FEES:
TOTAL '
POUCEIFIREI
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
MISC. FEES
NEW CONSTRUCTION [) D(PANSIONIADDITION
[ ] INTERIOR RENOVATION
Y N
- �
ADDITIONAL
SPECIFY:
TOTALALL
RESIDENTIAL [) COMMERCIAL [) INDUSTRIAL
PERMITS
FEES
I I OTHER (SPECIFY)
REO'D.
13. DESCRIPTION GFPROPOSED USE: ,lL11�iC I-,ait� V1, '
�f
REVIEWS ZONING ZONING
{
! PLANS -VEGETATION
SEA
MArIGROVE
I
14. Sq- Ft-ICONSTRUCTION: 0��9 .15. Sq_ FL 1sYFloar
'I - \ '
PEVIEWEDBY
f EXAMINING
TURTLE
16. VALUE OF CONSTRUCTION:
DATE
[
COMPLETE
The value Of cdn tlld n is treed to determine tha amount Of permit fees to be assessed_ SL Luoe County reserves the dght in ggestlom and/or modiy the
iodated value e Cb s /cr PI
_
.
of'cOnsWcSOrt.B it Fs delrrons9-ated.tttat U3e sub[rulled fgu2s ate not cdAsistent with s types ca'stmcSon adrnlies. H the sS2500
M rrrs=, 2 RECORDED
t
Notice of Corrwnenrxnwst must he su-orri[led with this app6r260r>_ .
SLCCDV Form NO.: 009-02
OWNER -'INFORMATION_
NAME:
ADDRESS:
CITY: LlD) V DABaatk STATE: �� ZIP .33!gx
PIIONE (DAofrIME): W) 'O' I DOO
IF TFIE FEE SIMPLE T(ILFHOLDER (PROPERTY OWNER) IS DIFFERENT FROMTNE OWNER LISTED ADOVE• PLEASE FILL IN NAME AND ADDRESS
DE t. 0W.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PFIOFrE (DAYT:...�,.
CONTRACTOR INFORMATION Op, �1 .
ST,. 61 FL REG.ICERT iI: C CBei 2oLt z
BUSINESS NAME: �1 „P tn+e-) . Q
QUALIFIERS NAME:
ADDRESS: A?3nI:
CITY:
PHO�IE (DAYTIME):
ARCHITiENGINEER:
A DDRESS:
C:n'Y:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRE- .
CITY_
MORTGAGE LENDER -
ADDRESS:
STATE:
ST. LUCIE, ..OJ::TY CERT 1:
ZIP
STATE:
1 �- ZIP 3 (o
FAX NO. 50- 53L- I Q-I Q
•,; .'�R�tJn1AIJ Frl(LnI��EI�C�.1G-
�rzrz(000 S_ I IIXIE HIGI-1W/�V �—y
If OCA RATrITI STATE: i lzip - 2.
IE) 1b .-:i79a- 3746
STATE:
ZIP
CITY-
STATE: ZIP
l iiPFDR°Ms ::T. :�F;CE_-`�dt;rn.a: e�rxsi4.➢s iss�z� a, :nz is rot: ;c}ied rip 3vothirr SO• da�;s
after notification R wiii be voided aria Tetornea to you )3y tnail-
CERTIS ICA f ION:
This application is hereby made to obtain a permit to do the work and
capacity, if applica, installations as' indicated, and as obtain a certificate of
blefoc itt
, the permed work I certify that no work or insiblIE on 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 lhisl6isdiction_ I understand that
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS. FURNACES. BOILERS, HF-ATERS,
TANKS, AND AIR CONDITIONERS, ETC., not otherwise.included with this building permit applicalion.
The following building permit app6r-Ziio
structures (all typesns are exempt from undergoing a full concunency review: room additions, accessory
residential use. ), swimming pools, fences, walls, signs, screen rooms, utility Substations'& accessory uses ID another non -
NOTICE 70 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 7FIE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT TITLE AND
INTERESTTHAr 1S'SUBJECT TO ATTACHMENJT: 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-
OJIMER/CONT CTOR SIGNATURE CON 1 IUMTOR SIGNATURE
STATE OFF RDA STATE OF FL R1DA
COUNT! OF (`�C� COUNTY OF� �iP0.Gi1
m
The foregoing- instrument } �wa�s� acknowled ed
before me this day of hic 2V$ by _
_ _, w o personalty known in me or who'
has produced as.identification,
Signature of Notary
Type or Print sine of Nolary�
NOlaIV Public Title
The foregoing instrument Aw,,aIrs acknowledged
before me this � day of V�, AQ5, by
D6`h*-� D: ! y who is personally known to me
or who has produced as identification.
C:;
Si/gnature of Notary
Type of Print Name of NJ
otar}
Noteiv Public Title .
Com=PubricState
Commission'Numtier
o`State of Florida
(seat) ll �n DD458803 s8 nemNotary Pubfc State of Florida
nd°2009 Kathy Ingersoll
_
... K ff . My Commission DD458603 .. .
NOTE: TWO (2) SIGNATURES ARGNAT`E REQUIRED_ EACH SIn�4 Mires 102312009
1F APPLYING FOR THIS BUILDING PERMITAS AN OWNEE2/BUILDER TT E OWNER 1riUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPL-ICATTON.