HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONs
DATE FILED: 01 11$ 10!5
PLAN REVIEW FEE: 100, RECEIPT NO.:4945 PERMIT NUMBER:
ALL INFO MUST BE COMPLETE 8L FILLED IN TO BE
�y�lE 0 �y� ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
�ORI�P FORT PIERCE, FL 34982-5652
772-462-1553
SCANNED
BY
St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 8I qJ 3
2. S/D NAME: 0--r' r\c--QL-6 SITE PLAN NAME: G
3. PROPERTY TAX ID
4. LEGAL DESCRIPTION (attach extra sheets if necessary): -r-Sig-ti A-
1C (� I L��-
5. PLAT, 6. PAGE 7. BLOCK l 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
10. DES/CRIPTION/ OF CONSTRUCTION
/PROJECT
TOOR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: t BACK: �t RIGHT t LEFT
' ! B -- SIDE �_ SIDE: '
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] J2ESIDENTIAL [ ] COMMERCIAL
[�/ OTHER (SPECIFY) e/l(ac-e,m an,-4— A-,,
13. - DESCRIPTION OF PROPOSED USE: 5?'—iQ
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
14. ' Sq. Ft./CONSTRUCTION: J f15. Sq. Ft. 1st Floor:
16. , VALUE OF CONSTRUCTION: $_
The value of construction is'usedto 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 cerisistent with similar types of construction activities. If the value is $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
d
SLCCDV Form No.: 001-02 _
OWNER INFORMATION- _-
NAME:
ADDRESS:
CITY:
SCANNED
BY
St. Lucie County
PHONE (DAYTIME): (I ' &I` -'2 T Lr
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:
CITY:
PHONE (DAYTIME):
STATE:
ZIP
CONTRACTOR INFORMATION
ST. of FL REG.ICERT #: =l-f'o &001 Z! ST. LUCIE COUNTY CERT #: A o x l J
BUSINESS NAME: ;TCNnl eM6S Yyto-k le 4&,..,,p Se-rL, ,- ki-c
QUALIFIERS NAME: Tg�KA-5 6. SENN t u6,s
ADDRESS: P-0 , -30X 14-W
CITY: �i�t./1L4R N7,7//�'L STATE:1` ZIP 33FZ3
PHONE (DAYTIME): (SS i 'POJ `j O S W3 FAX NO. rdlo3 'q4,7 64 5::5'
ARCHITIENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
STATE:
ZIP
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: ZIP
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.
M
CERTIFICATION:
SCANNED
BY
St. Lucie County
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, 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.
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.
OWNERICON'rRACTOIT SIGNATURE CONTRACTdk SIGNATURE
STATE OF O IDA
COUNTY O
The foregoing instrument w�s,/ackno ledged
beforne this day of �vv y , 2l) by
IhATVO_�wholis personally known to me or who
J,roduced � as identification.
Sig atur o N ary
Type or Print Name of Notary
Notary Public Title Wncr M. ARMS'I'A *
�O9 ` My Comm Sq. uno
Commission Nu c> No. cc99%0
ll Persu�Nr+'a"^.11.pyrr40.
(seal)
STATE OF FjLOD/a
COUNTY O
The foregoing instrument was cknowle ged
before me this � day of _}) aV , 20 , by
fKArs Q/Iyll`h o is personally known to me
Twho has has ras identification.
UNla't_,'n'a
Sig ature of otary
Type of Print Name of Notary
Nota1y Public c' 1 NANCY M. ARMSTI�Nc
EA11 5 MY Canm"Eqb ii13105
Commis i � RV er x%cc 95S63
fIFersnuyrpe Il0m LD.
(seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEFVBUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
BP #: la
SECTION:
TOWNSHIP:
S
RANGE:
L.{ 'u
MAP NO.:
ZONING:
^!�
.{�1 , V
1 V1
LAND USE:
�1 1
LOT CVG %:
TAZ NO.:
SCANNE
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
BY
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SPRINKLERS
STORMWATE
ESEWER:11/90)
R
LOT OF REC (befr 1190)
F REC (aRrLOT
SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
NUMBER
LIBRARY
IMPACT FEE
PARKS
PERMIT
��cJ•�
IMPACTFEE
FEE
j REPORT
CODE
PUBLIC BLDG
HABITABALE
RADON FEE
IMPACT FEE
AREA
(RADON)
ROAD
GROSS ROAD
CREDIT
Y N
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
SCHOOL
CREDIT
Y
N
TOTAL�-
IMPACT FEE
SCHOOL
•
IMPACT FEE
y'
$11 , v,
POLICE FEES
FIRE FEE
MISC FEES'
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
PERMITS
SPECIFY.
TOTAL ALL
FEES
REQ'D
REVIEWS
ZONING
ZONING
PLANS
'VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
2
COMPLETE
l
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INITIALS
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