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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY BP # SECTION TOWNSHIP RANGE MAP NO. ZONING ��� LAND USE �/� LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX H CONST TYPE OCCUP TYPE CUP # OF FLRS WATER SEWE SPRINKLERS STORMWATER LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT - before 1/90 I/90) REQUIRED APPROVED -Y Y t2.`i,Y.� -`H 4t .rv` 5 uS Y jS _ Y 'b 'Y ..?sh 4f k nII•• u- Y Yw'�'� i 44i"1. � 2 h Y Y.f"' � j' S t"'"y[uy I.4 � 5 +� _••�y���. �L nth �,�{ .F 3� f. t 4 ---c. S..F,f .v�al_p 2 -l., u'�. ,b-E ?�a e-%'R✓�-i._:.-u 8"..,_`�ii�`-V'�iA o.»Lv. <-.^cam" eFi 9.4 k.^"r=:";p L4n'•e-.d:8 e,�. -aro %�.�. �-.-u}.�43h<v![s..c ADMINST LIBRARY PARKS - T VARIANCE IMPACTFEE IMPACTFEE .FEE REPORT PUBLIC BED HA LE RADON FEE CODE IMPACTFEE A (RADON) SCHOOL GROSS ROAD CREDIT Y N TOTAL ROAD IMPACTFEE �- IMPACT` =• IMPACT FEE D, \ h SCHOOL CREDIT Y N " rh , "" t TOTAL IMPACTFEE ;. s. '� "�F .� �" SCHOOL IMPACT FEE POLICE FEE FIRE FEE MISC FEE TOTAL POLICE/FIRE MISC FEES ADDITIONAL Y N SPECIFY TOTAL PERMITS , r r.a,.<;. , of ALL REQUIRED •;,�� { .FEES .��`" 2, ° 't '� r.. , , � . < ..•d-� z ,..:.v, , a �-..?. :�.�,r."�,....,, a,t'._.,.r�..: r..�'.,_ �.:�..';`� , �_- <� •?> _�r�.+:.. ,•r=y REVIEWS ZONING_= ZONING PLANS MISC. VEGETATION.. SBATURTLE MANGROVE REVIEWED BY EXAMING °- DATE=: ;,: ` ......... COMPLETE INITIALS .D OFFICE USE ONLY: / DATE FILED [ — 0 J PLAN REVIEW FEE: RECEIPT NO.: CONCURRENCY FEE: RECEIPT NO.: PERMIT NUMBER: 0 620 I CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED �. SCANNED; St. Lucie County Building and Zoning' ' � BYFYtr �. 2300 Virginia Avenue �ORIOp' Ft. Pierce, FL 34982-5652 St. Lucie County" 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE ss�� PROJECT'INFORMATION I. LOCATION/SITE ADDRESS: d 3 40 1 - fZ 1 J C5 2. S/D NAME: SITE PLAN NAME: 3. PROPERTY TAX ID #: YSOy-Ga�-d013 �OaC!—`i 4. LEGAL DESCRIPTION (attach extra sheets if necessary): P^ 111 C M S�l] LnT _i- L ESS S 3SFT L+ND l jFSS Ty*w Pnkr DF N /NS 7ff I:T D F S life-w Ff i-YG OFL / `19V F> 5. PLAT 6. PAGE 7. BLOCK 8: LOT BOOK NO. NO. NO. 9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVIITY: /�'Crit/Cl t/4¢-rrQ a 7:7)zaa �{J`�iZt44N� ilA-tsdsxC��' Sr C1 rN6 / �i+/ DBuL� / �od[2 � Sllu7'TEj� 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT: SIDE SIDE 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] ,NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [Lr RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIP.TION OF PROPOSED USE: 14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1st Floor: 16. VALUE OF CONSTRUCTION: S 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 most be submitted with this application. SLCCDV Form No.: 001-02 OWNER INFORMATION NAME: _(',tip 5QL Iilgt're1 CHARTER C00. ADDRESS: /9a0 N, W. C0I1E 4Cl9Z CITY: ! 'Tym - STATE: L ZIP 3 14 PHONE (DAYTIME): 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.ICERT di z C' ga' �r/i! I ' "' ''' ST. LUCIE COU_N BUSINESS NAME: QUALIFIERS V /Ik�ME: Sf YsC� � (J S ADDRESS: Co /SEA 1_7v117 CITY: / (H-Ltr L-C ty STATE: /_� PHONE (DAYTIME): (/l Ff="S3 FAX NO. S kE t�— ARCHIT/ENGINEER: \ i, ADDRESS: CITY: STATE: PHONE (DAYTIME): Lj BONDING COMPANY: _ ADDRESS: ' CITY: MORTGAGE LENDER: ADDRESS --- CITY: STATE: STATE: CERT # ZIP email: n 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. CERTIFICATIaw . ` 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 accurat a at all w ill be done in compliance with all applicable laws regulating construction and zo OWKER7CTMTRACTOR SIGNATURE CONTRAC G RE STATE OF FLORIDA STATE O LORIDA COUNTY OF MA-19--r t H COUNTY OF M /Irv' -r r �I The foregoing instrument was acknowledged before me this 24 day of-W4 cy, 2000, by OAr iuL p(- 2ov u; ,who is uersonally known to me or who has produced as idei�! � �t'�Missio,Y� `S' nature of Notary = -A: OD 196758 G�IJ li �MYfl.1 Z w wuw•;. Type or Print Name of Notary 'ry, ��ed ,......� Commission No. 100 Lot The foregoing instrument was acknowledged before me this 21{ day ofJAra,.gty 2001rby S-rC-"voo-N JA2ossv , who is personally known to me or who has produced as identification. -uli1F�'Jy0r11tlON BAnature of Notary 8 �'Fl-nlrl r% SKITII _�t MD196758 ;O Type or Print Name of NotaAjr y ebm e;:• oQ. Commission No. (J 01 %-7 SY �Q� Yi•5IA qP� NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION. For specific instructions see appropriate permit checklist. SECTION: ZONING: FLOOD ZONE: CST TYPE: WATER: LOT OF REC (befr 1/90) DECAL NUMBER j REPORT CODE ! ROAD IMPACTZONE SCHOOL IMPACT FEE TOWNSHIP: LAND USE: FIRM MAP #: OCCP TYPE: SEWER: LOT OF REC (aftr 1/90) LIBRARY IMPACT FEE PUBLIC BLDG _ IMPACT FEE GROSS ROAD IMPACT FEE DUE Y N CREDIT 1 POLICE FEE FIRE FEE - ..Y.. N -._ .. ADDITIONAL SPECIFY. PERMITS REQ'D REVIEWS ZONING ZONING REVIEWED DATE INITIALS RANGE: LOT CVG %: 1ST FUR ELV: MAX. OCCP: SPRINKLERS LOT SPLIT REQ'D PARKS IMPACT FEE HABITABALE AREA (RADON) Y N CREDIT MAP NO.: Gy ST. LUCIE COUNTY PUBLIC WO _KS ^C �, 1 BUILDING &ZONINGDEPART M T �`- 2300 VIRGINIA AVENUE TAZ NO : �OR10Q' FORT PI772-462-1553 CE, FL 82 5652 SCANNED BY St. Lucie County MAX HGT: APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE # OF FLRS: - i PROJECT INFORMATION STORMWATE 1. LOCATION/SITE ADDRESS: R ! i 2. S/D NAME: SITE PLAN NAME: LOT SPLIT APPRV'D 3. PROPERTY TAX ID 4. LEGAL DESCRIPTION (attach extra sheets if necessary): n; I i oz s S /A L uT- - L iF S ,3-S /-- PERMIT FEE 601 LESS -MyV '0 42r oP N 145. �8' Fr of S /�Ojf' FT LY6 <OV i! 14o rY RADON FEE 5. PLAT- 6. PAGE 7. BLOCK 8. LOT BOOK NO. NO. NO. TOTAL ROAD IMPACT FEE' TOTAL 'SCHOOL IMPACT FEE MISC FEES: TOTAL V POLICE/FIRE C:. MISC. FEES TOTAL ALL FEES VEGETATION I SEA MANGROVE 11 PARCEL SIZE: ACRES/SQ FT LOT DIMENSIONS DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: lZE�rt7 ZIG A%C b4iiAV� �/� tiJ� / ��N oeWS Jl eDr`3 / SETBACKS (ACTUAL) FRONT: BACK: ((( RIGHT LEFT SIDE SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [✓r RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. ,1 st Floor: 16. VALUE OF CONSTRUCTION: $�) 415-0— 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 R 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. a I r SLCCDV Form No.: 001-02 OWNER INFORMATION: /� \ C-i-114IrreR GC I P (7-R) (•S �o N`W Cry✓�L�cr.iz �''T'U Pr?-7 )� t- 1 77 y STATE: ZIP NAME: ADDRESS:-' CITY: PHONE (DAYTIME): 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): �— CONTRACTOR INFORMATION STATE: ZIP ST. of FL REGJCERT..#: C-3CO/S � 5,'I�� /� ST. LUCIE COUNTY CERT #: BUSINESS NAME: Kf/ _wo NV a iiiq l�d o l-d/J lzo4C.T61 L L C QUALIFIERS NAME: / AYTHO/JyI 6J14% I!11)0 ADDRESS: I �6 S- r- �0k;1 S / CITY: �O%ZThh SS�T. 1^ uE STATE: FL G ZIP PHONE (DAYTIME): O Q d01 - . f -74,S FAX NO. '7 % D ' 3 S6 ' 2,52 ARCHIT/ENGINEER: ADDRESS: CITY': PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE:' STATE: STATE: ZIP ZIP ZIP 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. 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. t O NER/CO RACTOR SIGNATURE CO kTRACTPRSIGNATURE STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The foregoing in trument was acknowledgqc§ The foregoing instrument as acknowledged e this day of &,_, 20�W byjbefore me thi day of , 2009 , by is personally known to me or who f} who is personally known to me has produced as identification. or w o has produced as identification. Signature of Nota 4 Type or Print Nam Notary Public Title (seal) MY COMMISSION Y DD 411472 EXPIRES: April22, 2009 ow adnwft"Ri&Uldwit c Commission Number r Signature of Notary %µY EILEEN M. GORMAN :v V: r MY COMMISSION # DD 411472 <�•• EXPIRES: April 22, 2009 80ndctl Tlw Notary P&cUWomb Type of Print Name o Notary Public Title (seal) Commission Number NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNE[JBUILDER, THE OWNER MUST PERSONALLY APPEAR IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 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.