HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSOFFICE %L)C
DATE FILED:
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BP #: �_ '��
PLAN REVIEW FEE: \) RECEIPT NO.:
[(�
'� PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
_. _
OFtGE
USE ONLY
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ALL INFO MUST BE COMPLETE 8L Ft LED_1N10_RE_ACCEPTED
SECTION:
I I
TOWNSHIP:
MAP NO:
L{rJ I)
Gym LUCIE COUNTY PUBLIC
3�5
RANGE:
LI I
BUILDING & ZON NG DEPARST.
TMENT
ZONING:
1 ^
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LAND USE:
,l
R V
LOT CVG %:
TAZ NO.:
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2300 VIRGINIA AVENUE SCANNED
�OR1D FORT PI561-462-115553ERCE, FL962 5652
BY
St. Lucie County
FLOOD ZONE:
A �5
FIRM MAP #:
� 13
1ST FLR ELV:
r7. OO
MAX HGT:
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APPLICATION for BUILDING PERMIT
CST TYPE:
OCCP TYPE:
R3
{
-CERTIFICATE of CAPACITY/ZONING COMPLIANCE
MAX. OCCP:
# OF FLRS:
I
PROJECT' INFORMATION
WATER:
SEWER:
SPRINKLERS
STORMWATE
'! 1. LOCATION/SITE ADDRESS: /`7 AQUA KA T%iZtVL'
h
R
_
2. S/D NAME: LclttAI7*KjLL �(i r %ef3Y I iFFS SITE PLAN NAME:
LOT OF REC (bet 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
'
REQ'D
APPRV'D
3. PROPERTY TAX ID#:
1
4. LEGAL DESCRIPTION attach extra sheets if necessary):
DECAL
LIBRARY
NUMBER
IMPACT FEE
PARKS
IMPACT FEE
PERMIT
FEE
_ A
t
REPORT
pUg
LD I O I LIC BG HABITABALE RADON FEE (F CODE IMPACT FEE AREA 2,,ttPLAT
5. BOOK
ROAD
GROSS ROAD
C
TOTAL ROAD
-
'
IMPACT ZONE
-IMPACT FEE
" IMPACT FEE'
DUE
a
SCHOOL
SCHOO
.
CREDITIMPAG
Y
N
TOTAL
FEE
:
SCHOOL
IMPACT FEE
POLICE FEE
FIRE. FEE
MISC FEES:
TOTAL
- ..
POLICE/FIRE/
-
MISC.FEES
n L // /�
ADDITIONAL
SPECIFY.
/
TOTAL ALL
PERMITS
REQ'D
e�frfc o7�
�
FEES
REVIEWS
ZONING
=BY
PLANS
VEGETATIONJYTLE
MANGROVE
r.
REAMINING
DATE
COMPLETE
T
INITIALS
LS
/1
I /L
6. PAGE 7. BLOCK 8. LOT
°9t"1 NO. j NO.. A NO. 19
9. PARCEL SIZE: ACRES/SQ FT. Jo ALIE;tFs LOT DIMENSIONS 3 7. 7] t X %/O. oa N
10 DESCRIPTION OFCCONSTRUCTIONPROJECT ORWORK ACTIVITY: uutLD NGtJ
SrNGLL F.A1`%ILY AGSll7�%UG`gyeiC
11. SETBACKS (ACTUAL) FRONT: BACK: / RIGHT LEFT
QO /5,/7 SIDE �_,zl' SIDE: Q3
12. TYPE OF CONSTRUCTION (Check all appropriate boxes) _
[[ NEW CONSTRUCTION j J EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)-
1
3. DESCRIPTION OF PROPOSED USE: Si i,lULE 'FAMILY Is
14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1st Floor:
o��=
16. , VALUE OF CONSTRUCTION: $ z� �. � �
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 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: C - C7pZFZ1Ct l` ECLO
ADDRESS: _ 3 '� D U ff,-K A 7;�
CITY: JF r i <ErJ B 6A GIt STATE: EL ZIP
PHONE (DAYTIME):
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
to
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
Cand 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.
FEE SIMPLE TITLEHOLDER: At/ i i'I
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
ADDRESS:
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
CITY:
STATE: ZIP
YOUR NOTICE OF COMMENCEMENT.
PHONE (DAYTIME):
( )
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
CONTRACTOR INFORMATION
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN
LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
ST. of FL REGICERT #:
C �iiDrl %B� % �ST. LUCIE COUNTY CERT #: C/;�j
BUSINESS NAME: _ 9ACC
2000 � su G, .
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wi be done in compliance
QUALIFIERS NAME:
/-t A�17f'�% �( I'� A7A-L IIJ
�
� with all applicable laws regulating constructi d z 'ng.
ADDRESS:
2O8 S.W. Poz7 Ste. LVC /C
BLVr7.
CITY:
Ogj- .fir L.ttctL�
STATE: 'F1-• ZIP .
TER/ • DNTRACTOR SIGNATURE CON-PKC-FC NATURE
PHONE (DAYTIME):
f77Z) 340-7Z2-2�, Ec-r G cr_4
FAxNO. C»z.) 340- 7304
' OF FLO A STATE OF FLORIDA
COUNTY OF a . COUNTY OF —zl due-e&
1
ARCHIT/ENGINEER:
�ARVE'f KDeANrnJ
ADDRESS:
77O� �� Ys C J iz' .
The foregoing instrument was acknowledge The foregoing instrument vas acknowledged
1( before me this day of�L-Yiit , 200�, by before me this 2✓ day of P/L 20L05, by
CITY:
1�0 R i S-I . LL)Uc
STATE: �Z- ZIP ,3 bZ
I � � who is personal�kn—own to me or who - , who' ersona y n
( has produced as identification, or who has produced
PHONE (DAYTIME):
1772 ) 4G6 - 6_5.0,?�
a
i,
Sig t of Notary Signature of ary
Lance R Power
BONDING COMPANY:
AJ
1 �s7 4J(f � My Commission DD244188
rAR490y A1#AWX1N. / �����
ADDRESS:
! Type or Print Name of Notary Type of Print Name of Notary ExpiresOC10be`os zoos .
CITY:
STATE: ZIP
i
Notary Public Title Notary Public Titie
-
Cc i Mz4*4✓O Commission Number
MORTGAGE LENDER:
/`�/
.I o�ryrvu°�. -MARGERY NADALIN
ADDRESS:
1 seal a�, seal
M}' CA;.iMiS510N m CC 973333 (seal)
Jan 15.20115
CITY:
STATE: ZIP
off lllle EXPIRES:
I 1aoo-3-1,10TMY R Noiery Service& 8nnClna,1rA,
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
after notification it will be voided and returned to you by mail.