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Home My WebLink AboutBUILDING PERMIT APPLICATIONt; FILED - PLAN REVIEW FEE: RECEIPT NO.: _ PERMIT NUMBER: CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: A -LE IINFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING &CODE REGULATIONS DIVISION ��" `�' 2300Pierce, F 34982-56 Avenue Ft. Pierce, FL 34982-5652 772-462-1553 . . I N, APPLICATION for BUILDING PERMIT `S J CERTIFICATE of CAPACITY/ZONING COMPLIANCE (0 1 {S PROJECT INFORMATION I. LOCATION/SITE C tic, Nil S 6c e . D SS: _ t 2. PROJECT NAME: (t CC 'SIT!E-�PLAN N 3. PROPERTY TAX ID 4. LECIAL ESC PTION (attach ex sets if�'/eceSs �' I r '1 CaV 5. PLAT BOOK ctiS 6. PAGE NO. �5 7. BLOCK NO. 8. LOT NO. 0 10. PARCEL SIZE (ACRES/SQ FT.): D-13LO -QCdS g1%IMENSIONS: D70 � �36Q St. 11. SETBACKS (ACTUAL) FRONT: e' i BACK: —LjtL•F RIGHT SIDE: ELEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION DCi- EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 14. SQ. FT OF CONSTRUCTION: q,1-7 V 15. SF. FT 1 st FLOOR 16. VALUE OF CONSTRUCTION: $ _ ' D / valuA so, r1rO. oo = 44cjE &4,0D ✓fit. Poptwener• e 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 a, 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 o Jo3-Ca.16 i i rt 7 $ •F %rR &iCn�<SS (_�j�� G i/ 78y UPDATED 6/25/09 C CS�J C.i#' /oy.3/ X3Fgs 1P OFFICE USE ONLY: DATE FILED: PLAN REVIEW FEE: CONCURRENCY FE 5. 9. to. It. 12. 13. 14. 16. RECEIPT NO.: PERMIT NUMBER I I RECEIPT NO.: CERT.CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO "Jul ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING &CODE REGULATIONS DIVISION 2Pie Virginia Avenue A ' Ft.P772- FL34982-5652 G 772.462-I553 �,K& APPLICATION for BUILDING PERMIT � !01� CERTIFICATE of CAPACITY/ZONING COMPLIANCE (0 L, L4 LOCATION/SITE A DN S: PROJECTNAME: ITtiI{7'Y SI PROPERTY TAX ID if 1111 Ci - PROJECT INFORMATION _ SITEPLAN - f' fir)- Ili' PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. PARCEL SIZE (ACRES/SQ FT.):�dGIMENSiONS: -7043C V SETBACKS (ACTUAL) FRONT. =� BACK: �1� R TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION EXPANSION/ADDITION [ ] RESIDENTIAL COMMERCIAL [ ] OTHER (SPECIFY) DESCRIPTION OF PROPOSED USE: SQ. FT OF CONSTRUCTION: 41 VALUE OF CONSTRUCTION: 3 Z VI SIDE: PM T LEFT SIDE: [ ] INTERIOR RENOVATION [ ] INDUSTRIAL 15. SF. FT 1st FLOOR., twULr F , I The value of construction is used to determine the amount oroermit Res to be assessed. St. Lurie Countyreserves the right to question'�d/�hllRlhtpt�fw-k3� K value ofmnumclion iris isdemonstmted that the submitted figures cow not consistent with similar types ormnstmction activities. Irthevalue"2500ormore.o + RECORDED Notice orcommmeement must be submitted with this application. SLCCDV Form No.: 001-02 /�E.QinZj�# o fo3-a3/G = i�B n1ea,�ile DEPARTME UPDATED 6/25109 Y. 7s c OWNER INFORMATION NAME: CITY: • STATE: V M ZIP.. )yl"I0 PHONE (DAYTIM jIC) � ^ ( Email: po"0r 11Ab COA IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM OWNER WNER 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 • 5 �� ST. LUCIE COUNTY CERT #: o��T I BUSINESS NAME: !tit QUALIFIERS NAME: �rgr%A lAP CITY: iGIN\ (iS i STATE: ,'` ZIP: PHONE (DAYTIME):j— NO 7�� a�Zj 75ttll Email: ARCHITIENGIN'EtER7 11,V ADDRESS: lOJ CITY: N\- STATE: ZIP: PHONE (DAYTI(vlE): t-oU) BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: 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. OFFICE USE ONLY BP #: /Dla2 -/J7 SECTION TOWNSHIP 3% RANGE Ll/b MAP NO. ZONING LAND USE /,CCII �,-/� LOT CVG % TAZ NO. %�— FLOOD ZONE FIRM MAP # I� FLR ELV MAX HGT CONST TYPE l OCCUPTYPE MAX OCCUP #OFFLRS —� 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 PU C B IMPACT FEE CORRECTION PUBIC B IMPA FEE G ERAL PARKS IMPACT FEE SCHOOL IMPACT FEE ROAD IMPACT FEE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT FEE DRIVEW REQUI Y N DRIVE Y FEE ADMINISTRATIVE VARIANCE FEE SPECIFY SUBS REQUIRED MECHANIC ROOF ELECTRIC GAS PLUMBING ON CO ORMING L RECORD FEES MISCELLANEOUS FEES DATE SENT TO ADDRESSING: REVIEWS FRONT COUNTER ZONING SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED REVIEW f'6f 02.0y./ DATE COMPLETED OLL INITIALS 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. kYN�R i)R CONTRACTOR SIGNATURE CONTRA SIGNATURE STATE OF FLORIDA STATE OF O A COUNTY OF JA Ct VAj t, % COUNTY OF y{�► N The foregoing instrument was acknowledged before The foregoing iiinnstrument was acknowledged before me this.`] day orrf��_20 (f j me this AU day ofn , 20� by FrCA l IL C(/ (YLa— by 3Ck StCJVI 0CN 0,_ who is personally known _ or has produced who is personally known —or has produced as identification. as identification. afore of Notary --a— ' nature of Notary Commission No. U s V6'�i Sea11DOMMISSfON # DD724137 Seal "ORI WARNE YY ommission No. .;"9'6U,F; ( � �- ��" EXPIRES Ocloher 11, ly7`i COa'iAMISSION # DC '.='oan';�• ,,� EXPIRES October 11 (d0713S8-0A3 FloddaNWNSarvbo.com Rw!n4; r.;p'A" 3-C".53 FlgddaNWMSON�: G NOTE: TWO (2) SIGNATURES ARE REQUII2ED. EACH SIGNATURE MUST BE NOT ED 'IF PLYING 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 AFFH)AVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist.