HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY: M O /
BP #: J�0/0_0ff_s
i
OFFICE USE ONLY
SECTION:
c2r
TOWNSHIP:
3
RANGE:
MAP NO.:
a
ZONING:
'IL
LAND USE:
/77
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP M
1ST FLR EL
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF C Cb 1/9D)
LOT OF REC (aft 1/9D)
LOT SPLIT
LOT SPLIT
REO'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
i NUMBER
IMPACTFEE
IMPACT FEE
FEE
REPORT
' PUBLIC BLDG
HABITABALE
RADON FEE
--
CODE -
_�_ Xe - _
•
IMPACT FEE> 1,
' .• :
AREA
�' —
i _
-
_
(RADON)
Y
N
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACTZONE
IMPAcrFEE
IMPACTFEE
DUE
Y
N
SCHOOL
CREDIT
TOTAL -
impACTFEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICEIFIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REOD
REVIEWS
ZONING
ZONING
PUNS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
�/ 9Z
COMPLETE
o
INITIALS
��/
DATE FILED: � - 22D y _
PLAN REVIEW FEE: RECEIPT NO.: a-&ff PERMIT NUMBER: aYyl17�QS
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MAST BE COMPLETE 8z-FILLED IN TO BE ACCEPTED
- 44 gam' ?
ST: /c LUCIE COUNT* PUBLIC WORKS c E�Ecrrie
BUILDING&ZONING_DEPARTMENT--- 10[2410100%O
—72 23DOVIRGINIAAVENUE
'20R10 / FORT PIERCE, FL 349823852%
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1.
LOCATION/SITE ADDRESS: 3o3,4F [6A-k_-s 6yY Aj
2.
S/D NAME: SITE PLAN NAME:
3.
PROPERTYTAX ID #:
4.
LEGAL DESCRIPTION (attach extra sheets If necessary)
N '.
..5.,_
PLAT 6_ PAGE 7. BLOCK_,,: , , _
"
,= 8. LOT
BOOK NO. NO_. "
NO.
9.
PARCEL SIZE: ACRES/SO FT. LOT DIMENSIONS
10.
DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTNIIY:
q9WaP/toN
WA -Ls OC-' -Tvo &i:rz1LjA po_ o -' m &yt -5
�it>,�-��j• M/hVlA 75 7a/3e
SET6ACI&RCT ) FRONT: BACK: RIGHT
LEFT
SIDE
SIDE:
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes) \ ,
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [
] INTERIOR RENOVATION
(] RESIDENTIAL [ ] COMMERCIAL [
] INDUSTRIAL
OTHER (SPECIFY) 1AJ7a<RPo/2__ Lz^%WgX177,a4 l
13.
DESCRIPTION OF PROPOSED USE: .4loms E-
14.
Sq. FLICONSTRUCTION: 15. Sq. FL 1st Floor.
16. VALUE OF CONSTRUCTION: $
The value d oonsbuetion Is used b determine the amount or Wn t fees b be muted. SL Lude Canty marm the tight b quattlan www nxdfy the
Ir dicaW vabe d v nsbuCim If 8M the Is dengmtrated r sub ntWd Bplaes are not em'uhtent w8h sh ift on of txmbndlon adMtin. H to value Is SM
or more, a RECORDED Notice of Camlencement must be sAnftd with M appYmtfon.
Sorm No.: 001-02
OWNER INFORMATION:
NAME:
ADDRESS:
CITY: �,/z'T "r !� STATE:ZIP
PHONE (DAYTIME): WX2,r q-g Q- 3Z
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: - STATE: ZIP
PHONE (DAYTIME): I 1
CONTRACTOR INFORMATION
ST. of.FL REGJCERT %:
BUSINESS
QUALIFIER
ADDRESS: 2�o�/� - lii ' S, L�
CITY: j�4 '�'! Ay STATE: ZIP
PHONE (DAYTIME: Y/2— 1 46 - 741r7 FAX NO. 7,92- `tffv 7-91?5
ARCHIMENGINEEk - . Nf
ADDRESS:
CITY: `-� - .... - -:-v STATE - _ ',ZIP. -
PHONE (DAYTIME): r 1
BONDING COMPANY:
ADDRESS:
CRY: t - _ • • STATE: ZIP
CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certific
capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a i
and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understar
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEA'
TANKS, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
The following building permit applications are exempt from undergoing a full concurency review: room additions, accE
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to anothe
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PA
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OE
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOR
YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT_ TITLE,
INTEREST THAT IS SUBJECT TO ATTACHMENT: AS A CONDITION OF THIS PERMIT
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION
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 compli
With all applicable laws regulating construction and zoning.
tl�v— AJ
I
OWNE ONTRACTOR SI NA URE O CTOR SIGNA RE
STATE OF FL Q� DA, STATE OF FLORIpA
COUNTY OF COUNTY OF
The foregoing i trument acknowledged
before me this day of�, 20 by
AC��who is personal known to me or who
has produced - `D k 'Gas identification.
�,��-moo` �, �,..,
Signatu of Notary �-`— 7/
Type or P ' t Name of Notary
The foregoing ' strument was acknowledged
before me this 202 , by
ally known to me
AjAl—a-Ai
or who has produ,iddeenttlfic�ation.
Signature Notary
Type of,,Pdnt Name of Notary
AUDREY& MPHREY Commission Number
MORTGAGE LENDER: .•.,a�'�•�'°°`v.
_ ;,; MY COMMISSION N DO 190387
ADDRESS: (Seal) i• EXPIRES: March 6, 2007 (Se81) •'wF? AUDREYB. HUMPHREY
_ '•luf',PP ft.,• aondod That Notary PUM Undemmers ' •'
CITY: STATE- ZIP MY COMMISSION # DD 190381
=s'. gig; EXPIRES: March 6, 2007
�d'o•` Bonded7hru Notary PubriC Undery rs
i I
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MU
IMPORTANT NOTICE: When a permit is issued and It Is not inked u within IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERIBUILDER THE OWNER MUST PERSONALLY APPI
p p p 6O days 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.