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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION•"F,E, x j o a as 3 se RgR r'?t .f-� I i �Cjm= 4 -�"+'R•.'" Y- @ l� 'nijd��..� tom„ -yam yi x... r v25 dr � e�Yl . ...�ixiiA .� �T •-Y .'�. "1v� s.« =M� i� �Y 3��3 ,-._.v�, � - -. Y:. � f •• • v y • SCHOOL • ®®®® ADDITIONAL®® PERMTS. REQUIRM TOTAL of ALL. FEES •: �. ®®ice I I I I DATE FI1 ED: (0 •(7� PLAN REVIEW FEE: SIJ• W' RECEIPTNO.: PERMIT NUMBER: �I 05) D CONCURRENCYFEE: RECEIPTNO.: CERT.CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St..Lucie County Building and Zoning f- 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 772462-1553 APPLICATION for BUILDING PERMIT - CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION SCANNE® _ BY „ St. Lucie rminei, I . LOCATION/SITE ADDRESS: % 06 2 /Yed E W/w Ds J 2. S/D NAME: Co oa d L (:�- I%S1TE $LAN NAME: . 3. PROPERTY TAX IDC/2 4- LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT 6. PAGE 7. BLOCK BOOK NO. NO. 9. PARCEL SIZE ACRES/SQ FT. LOT DIMENSIONS " 10. DRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY IL SETBACKS (ACTUAL) FRONT: BACK: RIGHT: SIDE 8. LOT NO. . LEFT: SIDE -12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL ] OTHER (SPECIFY) ^ 1 it F 11� 13. DESCRIPTION OF PROPOSED USE: ��,aR�l/kcµ 14. Sq. FtJCONSTRUCTION: 15. Sq. Ft Ist Floor: I & VALUE OF CONSTRUCTION: $ The value of construction is used to determine the amount ofpermit fees to be assessed- St. Lucie County reserves the right to question andfor modify the indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activitim if the value is S2500 or more, a RECORDED Notice of Commencement must be submitted with this appiication- SLCCDV Form No.: 001-02 CERTIFICATION: OWNER INFORMATION NAME: �laN xRete Mr��C' sJ ADDRESS: !�35� 'Ua2/hGcLlfl' �c�r 4 2 - CITY: iP_eer .-L STATE: zip '4GS' r7 PHONE (DAYTRAE):IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAMEAND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): (_) CONTRACTOR INFORMATION ST. of FL REGJCERT # ! i BUSINESSNAME: QUALIFIERS NAME: ADDRESS: A 3 , CITY: )C'T I PHONE (DAYTIME): ST. LUCIE COUNTY CERT #: 01 3J e /r, STATE: L 21P FAX NO. _ - email: N eA0ik r�A% Zd�4GOM ARCHITBNGINEER:;J D " Ic (' . 4 7, Z ADDRESS: gs'? 5/ S a=S4xY CITY: STATE: ZIP PHONE (DAYTIME): lr '�7 z1&S -7045 BONDING COMPANY: ADDRESS: CITY: STATE: ZIP MORTGAGE LENDER: ADDRESS: CITY: STATE: ZIP IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 (Tays after notification it will be voided and returned to you by mail. 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 conciurency 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 YOURNOTICE 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 PERMrr YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN_ LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBIECT 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. OWNER/CONTRACTOWNER/CONTRACTOIR MNATURE NTRACTORSIGNATURE STATE OF FL7A COUNTY OF, Z6ecjZt The foregoing insty� lent ac wledged before e.t�%is ay of 200Vby A& W f f/F ho is personally kno to a or who has produced tf, a as identification. " t -v i M4 0 or Pri nnnnrNnn r ROBERT J. LOWE uission s ltvcoluus�� o2011 9�akk 1$Nnl STATE OF FLORIDA COUNTY OF 514,6,iCAe The foregoing i ument acknowled d �bef�o�re e this day Qf-1 g by I�IXWCIi 7 �/�%1 OW who is personally known to [fie or �who has produced pit VRL�2✓; �G I as identification- r 2 Uri r4J 32 L qVq u r-( D Type or I-0LO}M,rN[Y - R Dumml Asac Cu ' Id061NOTA¢Y - NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BULLING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN_ THIS APPLICATION INTTHE OFFICE LISTED ON THE FRONT OF THE APPLICATION. For specific instructions see appropriate permit checklist. SECTION: TOWNSHIP: RANGE: ZONING: LAND USE: LOT CVG %: FLOOD ZONE: FIRM MAP #: 1ST FLR ELV:. I CST TYPE: I I OCCP TYPE: I . I MAX. OCCP: I WATER: I I SEWER: I - I SPRINKLERS LOT OF REC (befr 1/90) I I LOT OF REC (a0r 1190) I I LOT SPLIT DECAL LIBRARY PARKS NUMBER IMPACT FEE IMPACT FEE REPORT PUBLIC BLDG HABITABALE CODE IMPACTFEE AREA BP #: 051a- 051W MAP NO.: TAZ NO MAX HGT: # OF FLRS: STORMWATE R LOT SPLIT APPRV'D PERMIT FEE RADON FEE Y N ROAD GROSS ROAD CREDIT TOTAL ROAD IMPACT ZONE IMPACT FEE IMPACT FEE DUE Y N SCHOOL CREDIT : "` TOTAL IMPACT FEE �; SCHOOL IMPACT FEE POLICE FEE FIRE FEE MISC FEES: TOTAL POLICE/FIRE/ _ MISC. FEES Y N ADDITIONAL SPECIFY: TOTAL ALL PERMITS FEES REUD REVIEWS .. ZONING ZONING PLANS 'VEGETATION SEA - MANGROVE DATE INITIALS I I I oF�Fras)tol. LY DATE FILED: �c 7���/\ PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: W1r� —CEO V CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MAST BE COMPLETE u FILLED IN TO BE ACCEPTED - itCo saS- �,�, Sa5-- ST. LUCIE COUNTY PUBLIC WORKS SCHNIVF®BUILDING &ZONING DEPARTMENT BY 2300 VIRGINIA AVENUE St lU FORT PIERCE, FL 34982-5652 Cie riourity 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITYMONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: W-Wc? J/12 n 11/2 2. S/D NAME: (�OIral COUP SITE PLAN NAME: 3. PROPERTY TAX ID #: 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT. 6. PAGE 7. BLOCK 8. LOT BOOK NO. NO. NO. 9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: ee �r� w (I w 11. SETBACKS (ACTUAL) 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) 13. DESCRIPTION OF PROPOSED USE: 14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1st Floor: � 16. VALUE OF CONSTRUCTION: �J 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 H 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 OWNER INFORMATION: NAME: - ADDRESS: - CITY: - PHONE (DAYTIME): j 7�S- S a STATE: of V ZIP 2C__C_0y 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): jam_ CONTRACTOR INFORMATION STATE: ZIP ST. of FL REGJCERT #: l L? CA © / C 6 5� S(T.. LUCIIE�COOUNTY CERT #: BUSINESS NAME: QUALIFIERS NAME: (I^ lye I..� P • �q ��c��1� ADDRESS: CITY: y d -� (.IJ G�/.�0� _ STATE: ZIP G PHONE (DAYTIME): !�P' FAX NO. ARCHIT/ENGINEER: J S L I` V A 2Z ©o CZ_ ` . ADDRESS: yY��1 U _-) 1 1 _;)(')(A 7 H. CITY: I^� Q T f !I r-��L Q STATE' PHONE (DAYTIME): ! i -1(D BONDING COMPANY: ADDRESS: CITY: STATE: MORTGAGE LENDER: ADDRESS: CITY: STATE: ZIP` 80 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. ,GW?IE CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OFF -', la n Al u e./ The foregoing instrument was acknowledged efore me this !l day of 13af-,, 200-5',-by V who is personally known to me or who has produced as identification. Si ature of Notary / Type or Print Name of Notary ZIP Notary Public Title JOYCE E. IDNDEL Commisgi N116tCOMMISSIONtDD445M EXPIRES: October 26,2fdg (seal) '1 �_ �P BmW ilw Balad Nalmy Servm 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. STATE OF FLORIDA COUNTY OF, -EN &(an �)✓e The foregoing instrument was acknowledged before me this[4 day of wig , 2009 , by r l)2 2lx A , who is personally known to me ho has produced as identification. Sig ure of Notary Typ6 of Print Name of Notary Notary Public Title JOYCE E. INDEL' Commission Nurp * MY COMMISSION 0 OD 445M EXPIRES: October26,2DO9 (seal) '��wme. a�aean.oeuaemNotmrsmrzs NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. P � DATE FB ED;ONI Y: i . 10CE PLAN REVIEW FEE: - RECEIPT NO.: Wd9( PERMIT NUMBER: CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED �JL\fi CpG St. Lucie County Building and Zoning 2300 Virginia Avenue SCANNED F�OR10p'. Ft. Pierce, FL 34982-5652 BY772-462-1553 St. Lucie County APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE I PROJECT INFORMATION LOCATION/SITE ADDRESS: 100 0 6hwr%e wards 1N N- F+• Pi,2rce 2. PROJECT NAMELNj 3. PROPERTY TAX ID #: 4. LEGALDE4CRIPTTOP 5. PLAT BOOK a 10. L —SITE PLAN NAME: C0-7 —= extra sheets if tea. t. / I 6. PAGE NO;3O PARCEL SIZE (ACRES/SQ FT.): 7. BLOCK NO. l 8. LOT NO. LOT DIMENSIONS: 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [I INTERIOR RENOVATION [ ] RESIDENTIAL OMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) ?'W[16�-7 13. DESCRIPTION OF PROPOSED USE: "-5—aLc 14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st 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 $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV FormNo.:001-02 J OWNER INFORMATION �T^ NAME: ADDRES CITY: . STATE: [Pf ZIP: PHONE (DAYTIME): (_ ) Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): ( 1 CONTRACTOR INFORMATION ST. of FL REG.CERT #: A; 15 *6; d ST. LUCIE COUNTY CERT #: y BUSINESS NAME: C-L vrkS �-AS toGlA k S QUALIFIERS NAME: CGut'r k S L Qvrk-s l ADDRESS: ISMS MatAY-4-kw j9W /� CITY: 44-I&II.I'LL STATE: C-lPC ZIP: ?03I$ PHONE (DAYTIME): _7jrJ5 iii6 3 FAX NO. yI1 55S S It q Email: ARCHI VENGINEER: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): (� BONDING COMPANY: ADDRESS: CITY: STATE: ZIP: 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 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. OWNERrIO CON CTOR SIGNATURE STATE OF FLORIDAQ I ( •(�A COUNTY OF lam The foregoing instrument was acknowledgedbefore me this. , 10 day of JO'-1 20y by l?g� S Y 1 I who is ersonally known _or who has produced L44 -1 W—I t?f> as identification. 8gnature oMotary t Commission No. I ,ti%',$eaa1111gEAIR000YCOCHEA y, ,r Ntt coMMISSION k DD 69W9 EXPIRES: July 2, 2011 ;�• `,�•` Bonded Th, Notary Public UO"Rem caQ,/ — - CONTRACTOkSIGNATURE STATE OF FLO A COUNTY OF P' > Onrc r The foregoing instrument was acknowledged before me this '9 day of =6<Q 20 O , by 014411_&J ISU2K-51 who is ersonally known or who has produced ?Or nev EXPIRES: May24,2010 (4 7)39MIM RWde Notary Sa cacom NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERBBUILDER, 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. OFFICE USE ONLY BP #: SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF RFC 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 BID IMPACT FEE 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