HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONDATE FILED l
PLAN REVIEW FEE: RECEIPt NO.�_
Ra
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER: +�
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
_BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue SCANNED
Ft. Pierce, FL 34982-5652
772-462-1553 BY
St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT IN
1. LOCATION/SITE 6{l
S. ., — 5 7FORMATION
2. PROJECT NAME; A
! n SITE PLAN T
3. PROPERTY TAX ID #: J _ _� �-00
4. LEGAL ESC PTION (attach extr sh ts_if�recess y ; ( u( t
`� f r 1 CoV 5 , k
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. } 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): -�3 f2S �{ OTDIMENSIONS: D-70 1l j ( D
10.
11. SETBACKS (ACTUAL)
12.
13.
BACK: ] RIGHT SIDE: h L{ LEFT SIDE:
TY E OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION
CC �j RESIDENTIAL COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROP(
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
14. SQ. FT OF CONSTRUCTION: O; 'l l 15. SF. FT I st FLOOR:
16. VALUE OF CONSTRUCTION: $000.
The value ofconstruction 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
UPDATED 6/25/09
80%%iC /72.2G, ArlF3QY,78y.22 . .
F099a SF-Cf. y7s, 212. 93
d�.c ene 9D n9LL-
OWNER INFORMATION
NAME:
CITY: SSTATE: n ZIP: 7yQ—
PHONE (DAYTBv1 ): 71 d J�� 1� J` j�( Email: Z __l Q Q/_��(( (0
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELO
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: .,STATE: ZIP:
PHONE (DAYTIME):
CONTRACTOR INFORMATION`'
ST. of FL REG.CERT
BUSINESS NAME: _
QUALIFIERS NAME:
ST. LUCIE COUNTY CERT #: `489 t
CITY: IG L STATE:
PHONE (DAYTIME): FAX NO. 71) ��' S'''` � �- TU Email:
ARCHIVENGINEER V
ADDRESS: '1 OD S4a a
CITY: ftse . ry3TATE: ZIP.
PHONE (DAYTIME): GQ� 1=�:7L2 1
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
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.
OFFICE USE ONLY BP #: Ol b
SECTION
I�
`/1J
TOWNSHIP
/_
RANGE
1LD
MAPNO.
ZONING
LAND USE
�WW7
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
h g D
o�
13T FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
1
t`•
SEWER
�C
J
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
(J v
HABITABLE
AREA
O
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
MACT FEE
CORRECTION
PUBIC BLD
IMPACT
GENERAL
PARKS
AQPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
INTAer
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC 1- /ROOF ,
ELECTRIC GAS
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUSO
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED2-22-11
INITIALS
r
!i
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 IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND 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 THIS 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:
A
SIGNA
STATE OF FLORA
COUNTY OF _
The foregoing instrument was acknowledged before
i__
me this I J' day of afl!A" 20 �(anV- PcM0 by
who is personally known x or has produced
SIGNATURE
STATE OF nORIDA
COUNTY OF (-1
The foregoing instrument was acknowledged before
me this day of �( 19!S4 . 20 U ,
by P(JYYK = —"
who is personally known I( or has produced
as identification, as identification.
Signature of Notary Signatdre of Notary
Commission No. ptil,31 iORI 1VAR6JEfYCom fission No. j�ll/F~!,
=• IVY COPAMISSION # DD72413 gy, S�'�Ri
��. •`° - MY COMMIS£ )0724
EXPIRES October 11, 20'It EXPIRES O
�•, I, 20'I
�....-Flodtlallolaryaon:ce.wm ,y��,,•p
NOTE: TWO (2) SIGNATURES A"RE-REQUiRED. EACH SIGNATURE MUST BE NO ARIZhI ; iiictltlPrYING 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.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.