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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSA 9 OFFICE USE ONLY BP #: Qq era — 0�VFi SECTION TOWNSHIP RANGE I \ l,� MAP NO. ZONING LAND USE {/� M LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # Et) Is"FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER\Tr ` SEWER �-( t SPRINKLERS STORMWATER LOT OF REC LOT OF RFC LOT SPLIT LOT SPLIT Before 1/1990 After 1/1990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE (^� — Q� AREA FEE FEE 1 (RADON) LIBRARY PUBLIC BLD PUBIC BID PARKS IMPACT IMPACT FEE IMPACT IMPACT T FEE CORRECTION FEE FEE GENERAL SCHOOL ROAD CREDIT Y N LAW FNF IMPACT IMPACT IMPACT 4 FEE FEE FEE FIRE/EMS DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE IMPACT REQUIRED FEE VARIANCE FEE FEE SPECIFY MECHANIC V ROOF _ NON -CONFORMING MISCELLANEOUS SUBS ELECTRIC _[� GAS LOT OF RECORD FE �s REQUIRED PLUMBING FEES DATE SENT TO ADDRESSING: L-aA!ry— REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLES MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED., DATE COMPLETED" INITIALS - - I I II I i OFFICEiUSEONLY: I P nucwn k DATE FILED: [('�� er. Luclu dduury " PLAN REVIEW FEE: 1051b RECEIPT NO.: CD PERMIT NUMBER: CqQq— C5 L5 CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED J 1EC G y St. Lucie County Building and Zoning F�r� is 2300 Virginia Avenue SCANNED /ORIOp'• ,y/��f1 1 Ft. Pierce, FL 34982-5652 BY 772-462-1553 St. Lucie County APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATIO//N�� 1. LOCATION/SITE ADDRESS: `� g�s' Vl[�Ci 1�1��' 17.o.i��t � %- 2. PROJECT NAME: K/ -e' ' , ^ r SITE PLAN NAME: 3. PROPERTY TAX ID #: 6 cgOF— Tess-- m B3 q�' m 0c 7 4. LEGAL DESCRIPTION (attach extra sheets if necessary): ✓' i '- tt 1A X s z 5. PLAT BOOK 6. P GE N0. 7. BLOCK NO. 8. LOT NO. Lq' q 9. PARCEL SIZE (ACRES/SQ FT.): r5 LOT DIMENSIONS: Z/ILV(- 10. COMPLETE ESCRIPTION OF CONST UCTION PROJECT OR WORK ACTIVITY: �-k n rLs�dG� Looms zT �,tJ t pplceCernenE 11. SETBACKS (ACTUAL) FRONT: BACK: � RIGHT SIDE: 155 LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [[ ] MMERCIAL/ / [I INDUSTRIAL [ ] OTHER (SPECIFY). Ii S IFCV VJZtl Cp <� L��y/ `�Oj� 13. DESCRIPTION OF PROPOSED USE: 5'¢ 14. SQ. FT OF CONSTRUCTION: ` 15. SF. FT Ist FLOOR: 16. VALUE OF CONSTRUCTION: $ 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 S OWNER INFORMATION NAME: 4) Q r n /� r J -e /a ✓ r— ADDRESS: 1, 3 ?- it 7 144 bra ..f� %� d,e✓ ✓ 1, cj p CITY: % • Gk.i c{+ Gp STATE: /m" ZIP: PHONE (DAYTIME): (i A 7-/ 4e Email: �— 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): (_. ) CONTRACTOR INFORMATION ST. of FL REG.CERT #: BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: 77, PHONE (DAYTIME):, STATE: /OFAXNO. ARCHIT/ENGINEER: '. ADDRESS: ' CITY: _ STATE: PHONE (DAYTIME): O J BONDING COMPANY: ADDRESS: CITY: STATE: ST. LUCIE COUNTY CERT #: Email: ZIP: ZIP: Ulm 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. CERTIFICATION: This application is herebymade 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 p4mitYapplication. St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build ilie 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 Homeowners Association and review your deed.foi 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: 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 A FIDAVIT: I certify that all the foregoing information is occur to and that all work will be done in compliance with all applicable laws regulating construction d zoning. O NER OR CONTRACTOR SIGNATURE C TRACTOR SIGNATURE STATE OF FLQI,iD)A ` COUNTY OF j- Gt^�y The foregoing instrument was acknowledged before me this %t '1O20 O by who is personally known Zor has produced STATE OF FLORIDA COUNTY OF 9- %nCN The foregoing instrument was acknowledged before me this day of by (41,, lnmrsl n�ra.. N"f who is personally known zor has produced as identification, as identification. SignaturtOlof Notary ignature o otary J. ELOISE GUMM. J. ELOISE CUMINGS CommissionNo.� �,.a,. 1AYCOMMISSIONCDDST1307 ommission No. ' • -' ` � my CdAM&ON #DD874307 Band ES- APR 1 ' a i EXPIRES: APR 08, 2013 d^� Bonded through letSM 1119=u NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH.SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUIEDER, 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 OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist. I OFFICE USE ONLY BP #: U3 SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1sr FLR ELV MAX HOT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC Before 1/1990 LOT OF REC After 1/1990 LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT CODE- HABITABLE AREA (RADON) RADON FEE PERMIT FEE LIBRARY IMPACT FEE PUBLIC BLD IMPACTFEE CORRECTION PUBIC BLD IMPACT FEE GENERAL PARKS IMPACT FEE SCHOOL IMPACT FEE ROAD IMPACT FEE €/,� CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT FEE DRIVEWAY REQUIRED Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE SPECIFY SUBS REQUIRED MECHANIC_ ROOF _ ELECTRIC GAS PLUMBING _ NON -CONFORMING LOT OF RECORD FEES MISCELLANEOUS FEES DATE SENT TO ADDRESSING: REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED DATE COMPLETED - INITIALS oFFIC8=USEtONL-'Y: �3009 DATE FILED: , O / PLAN REVIEW FEE: _(i RECEIPT NO.: %/// r� PERMIT NUMBER: /I— CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St. Lucie County Building and Zoning o I SCANNED 2300 Virginia Avenue �O1�vt2� 6x6(7 OR10 Ft. Pierce, FL 34982-5652 RV 772-462-1553 %.jai I/ /70 _lrfV- St. Lucie County �K h) APPLICATION for BUILDING PERMIT C. 6-4-A( CERTIFICATE of CAPACITY/ZONING COMPLIANCFxjuyn e"-) PROJECT INFORMATIOrnN ✓//j f 1. LOCATION/SITE ADDRESS: 2. PROJECT NAME: i`J .zN /R � �" SITE PLAN NAME: 5 3. PROPERTY TAX ID #: g"4),5my3 m m© , i 4. LEGAL DESCRIPTION (attach extra sheets if necessary): =" i %'t-.- ✓hb rr `_� ` ' ��" '' gt ti. thf oa JC. S 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRESISQ FT.): LOT DIMENSIONS: 'gel 10. COMPLETE//DESCRIPTION OF CONSTj,2UCTION PROJECT OR WORK ACTIVITY: M�l CY)IL {Q c� t PL.—' c.L S •cTc(J 100 //.]. v-1 X c-741 ` & 11. SETBACKS (ACTUAL) FRONT: 5 vBACM .12- [ F RIGHT SIDE: 15.5 LEFT SIDE: yq TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [I INTERIOR RENOVATION [ ] RESIDENTIAL ] CQMMERCIAL/ /` [I INDUSTRIAL [ ] OTHER (SPECIFY) ti ec.t/ I�%'GO La " '� DESCRIPTION OF PROPOSE USE: SQ. FT OF CONSTRUCTION: 1970 VALUE OF CONSTRUCTION: $ // 1m p G t 4. - L-4' ,-k- 15. SF. FT 1st FLOOR: 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 [7 OWNER INFORMATION n r NAME: 4) ✓ [Y J F r J✓ i ADDRESS: 13 ';L 7 CITY: L e, c P Gp "" STATE: /--/0, tease ZIP: PHONE (DAYTIME): (`i`!I) it 6 Email: 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): () CONTRACTOR INFORMATION ST. of FL REG.CERT #:. — — !Y ©_5e`iO 7/ V BUSINESS NAME: �l><f / J Ce a° Gr e QUALIFIERS NAME: ADDRESS: b r�l 0 �// S l^ X cA e c� CITY: �/ &P_ (S J"i> '<''�"?`? STATE: PHONE (DAYTIME):'M /OFAX NO ADDRESS: CITY: STATE: PHONE (DAYTIME): (_) BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: ST. LUCIE COUNTY CERT #: fi `rnl� �Cfu`e�f STATE: / -Y' 7 Email: ZIP: ZIP: 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. 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, 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: 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 A IDAVIT: I certify that all the foregoing information is accur to and that all work will be done in compliance with all applicable laws regulating construction And zoning. OWNER OR CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE STATE OF FLOktIDA ` COUNTY OF :-+— Gut �y The foregoing instrument was acknowledged before me this C9 day of <ppkny20�, who is personally known _Z or has produced STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this _day of by who is personally known 20_, or has produced as identification. as identification. SignatureSf Notary ignature of Notary t J. ELOISE CUMINGS87407YCOMSSAD3MN#D201 ommissionNo. (Seal) Commission 13 tOOS. 20 dSooicaouaIsISM11WinIh 5iaY NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. 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. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist.