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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONINF, 1MUST BE Cof,j u,.tETED FOR APPLICATION TO BE ACCEPTw J All APPLICABL ` Date: +� Permit Number:�9—� k 3� ^G✓ . SCANNED Building Permit Application BY Planning and Development Services St. Lucie County Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: Q PROPOS -D INPRO EMENT L©C*A ION: Address: Legal Description: Property Tax ID #: Lot No. Site Plan Name: Block No. Project Names / Setbacks Front ck: fight Side: —Left Side: ETAILED D -SC PTI©N ©F WO CON. WRR1li1ITNj1N,,5gR T 0 ]7rti a wor to a pe orme under tis permit -c ec a tat apply: Gas Tank _Gas Piping _Shutters - Wi dows/Doors /echanical VElectric ✓Plumbing _Sprinklers _Generator Pitch ;oof Total Sq. Ft of Construction: 0� Sq. Ft. of First Floor `�% 7 o< Cost of Construction, $ OCO stj�-_) Utilities: _Sewer _Septic Building Height: OWNER LESSEE: CONTRA O Name Name: Address: Vn) l FQ iny: City: ��t rh\t�C®l`lGS�Cu-& 0 Stater Address: City: A State:_ Zip Code:�RLF� Fax: Phone Nona �Q O� Zip Code: Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page ( if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. UP.P.LEMENMA I ORNSITIR... I.'.. LIE-N LAW INF.ORMAT.1 U;O.N: DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable BONDING COMPANY: Name: _Not Applicable — — Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use WARNING 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 lender or an attorney before rommencing work or recording vour Notice of Commencement. C Signature of wner L see/Co tra or s Agent for Owner Signature of Contractor/License Holder STATE OFF RI // STATE OF FLORIDA COUNTY OF COUNTY OF The f r ding mstru nt was ck awledged before me (�,y The forgoing instrument was acknowledged before me this: day of this —day of. 20_ by KAPU Zn-_-:S (Name of persona knowledgin a, a4�2�'6 _N (Name of person acknowledging) - (Signature of ary Public- State of Plorida) (Signature of Notary Public- State of Florida ) /n Personal tion 1/ Personally Known OR Produced Identification Type Of I R�x••• ANGELA M H F Type of Identification Produce =� • �`. Nota y Iic -State of Florida : n-M-FF-224730 Produced yyam�.. do-; My Comm. Expires May 27, 201 . COmmIS50r1't4Jf,;;F..•° ate.-�TonrnrnnnhNaiinnx�N[•$eal) • Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/Z014 OFFICE USE ONLY BP Mq• 0ds� SECTION TOWNSHIP RANGE MAP NO. ZONING In m Yl �J LAND USE , LOT CVG % 2_e�l C l ✓ TAZ NO. FLOOD ZONE FIRM MAPS IT FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 111990 After 1/1990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE (� AREA FEE FEE AR c�I(RAD(RADON)LIB PUBLIC BID PUBIC PARKS IMPACT ++ 1 IMPACIY IMPACT FEE IMPACT _ FEE v� CORRECTION FEES GENERAL SCHOOL ROAD N CREDIT Y O F IMPACT 15,q (;� S FACT ?� 11 — ]MPACTLAW FFE v FEE FIRE/EMS DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE IMPACT F[� S : i J • 'REQUIRED FEE, VARIANCE FEE FEE SPECIFY _ MECHANIC ' V ROOF NON -CONFORMING MISCELLANEOUS SUBS ELECTRIC',--, ', GAS LOT OF RECORD - FEES REQUIRED PLUMBING _� FEES DATE SENT TO ADDRESSING: �/ /=2> REVIEWS FRONT-'- ' -ZONING' -'- `SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW. REVIEW REVIEW REVIEW ." ' -REVIEW ' REVIEW DATE L4Zt RECEIVED DATE COMPLETED INITIALS -CERTIFICATE of CAPACITY/ZONING I. LOCATION/SITE ADD 2. PROJECT NAME:v1) 3. PROPERTY TAX ID #: E PLAN NAME: b ..gin/n- OFFICE USE ONLY, DATE FILED: n PLANREVIEWFEE: RECEIPTNO.: �// IZ CONCURRENCY FEE: QRECEIPT NO.: PERMIT NUMBER: CERT. CAP. NO.: _ ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue ` ,� Ft. Pierce, FL 34982-5652 ?(��(/(. - i'" Q 5 772-462-1553 <7/("w 4bi o y`S C �11t ' M eeh r- U�k ;O 0 ,G j A/G- . PLICATION for BUILDING PERMIT rn °4;1;� C PL CE i lY6 3494� �1774riTTA /!� . YA Jv 4. LEGAL DESCRIPTION (attach e�?j sheets if necessary): /10 l/1/ e 5 5. PLAT BOOK 6: PAGE NO. I t/ 7. BLOCK NO. S. 2 LOT NO. / t � 9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: fa%Na� 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY - II. SETBACKS (ACTUAL) FRONT: �! BACK: RIGHT SIDE: IVA 13. 14. 4Z oE)r- 16. VALUE OF CONSTRUCTION: $ TYPE OF CONSTRUCTION (Check all appropriate boxes) REW CONSTRUCTION [ ] EXPANSION/ADDITION SIDENTIAL [ ] COMMERCIAL [ ] OTHER (SPECIFY) DESCRIPTION OF;PROPOSED USE: LEFT SIDE: [ ] INTERIOR RENOVATION [ ] INDUSTRIAL 7 " 020 Z� SQ. FT OF CONSTRUCTION: O/ 15. SF. FT 1st FLOOR SCANNED BY St. Lucie County 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 demousnated 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 applimfion. SLCCDV Form No.: 001-02 UPDATED W25l09 OWNER I TORMATION NAME: a Y D o ADDRESS: w �: (( CITY: (J li;Y� (lie STATE: PHONE (DAYTIME): (7�,_y0L �f 2 7 Email:. IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT.FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAMEAND ADDRESS BELOW. ` r; FEE SIMPLE TITLEHOLDER: ' ADDRESS: �• CITY: STATE: ZIP: _ j PHONE (DAYTIME)= CONTRACTOR INFORMATION ST. of FL REG_CERT #r: BUSINESS NAME: QUALIFIERS NAME: C6 - CITY: ' �1�,N(i r PHONE (DAYTIME): (�,5 5 CITY: meyl c�/ rf 1( PHONE (DAYTIME): `--'4 BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER ADDRESS: CITY: STATE: FAX NO STATE: STATE: STATE: ST. LUCIE COUNTY CERT #: nr MAr J IMPORTANT NOTICE: When a permit is issued and Wig not picked up within 60 days after notification it will be voided and returned to you by maiL f CERTIFICATION: work and installations as indicated and to obtain a certificate of capacity, This application is hereby made to obtain a permit to do the 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 PAYING TWICE FORIMPROVEMENTS TO YOURPROPERTY. A NOTICE ONCEMENT MAY RESULT IN YOUR COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WPPH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT: IF IT IS NOT YOURRIGHT, 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. OWNER C N SIGNATURE CT O IGNA �m<a STATE F O 11 z a v STATE OF O CO O ° in m COUNTY OF ��o' �m z� The foregoing instrument was acknowledged befo w m = The foregoing instrument was acknowledged before me this day of 20 me this _day of by by M v who is pe nal own or has produced ;R who is personally nown _ or has produced ?a.;t as identification. • as identifica Signature o otary 2 M 8 M Signature of NotiVy Commission No. (Seal) Commission No. (Seal) m O NOTE: TWO (2) SIGNATURES ARE REQU aN L 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.