HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0- CE USE QNI Y: T
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PLANREVIEW FEE: — RECEIPT NO.: 1 �o�V PERMIT NUMBER
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia-Aveme'
SGANNFD Ft Pierce, FL 34982-5652
BY 772 462-1553
St. Lucie COu* J`l
)p0t iio y-oo?q APPLICATION for BUILDING PERMIT Ca
CERTIFICATE Of CAPACITY/ZONING COMPLIANCE `
��) PROJECT INFORMTION
1. Oi /SI'' DRESS: J Y/CAS1 J . US 1 WO
et�o%6C fBE
2. A-M9 tp J )2M SITE PLAN NAME:
3. Ro�E> T rA _ (D - 3� I I oo ao 0o0 3
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. °PAGE NO.
7. BLOCK NO. f 8: LOT NO.
9. PARCEL SIUE (ACRES/SQ FT.): LOT DEVIENSIONS:
10. �Q 00TE?DESGR ]FH6iFS@ CONSTTRUCTION PROJECT OR WORK ACTIVITY:
� ( o,rn min ( �r ��,t�4� .,e - �,� ' no ���1 �L r, .r /,
III SETBACKS (ACTUAL) FRONT: BACK RIGHT SIDE: LEFT SIDE: _
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[I NEW CONSTRUCTION [ ] EXPANSIONlADDITION .kRr1FERIOIPRENOVA4rI0
[ ] RESIDENTIAL INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. " SQOFMTR�GTIQN:'_
15. SF. FT 1st FLOOR 1Z 60 (Fr.
16. "&kVAI3UEIOF NS1'1LCJdfTON =$ r
�K3S'O, 0 -on. clER CaOMrA-09Cr - Em0&4
The value of construction is used to dete nine the amount ofpmmk fees to be assessed St Lucie County reseeves the right to question andlor modify the indicated
value ofconstruction ifit is demonstracd thatthe submitted figures arc not consistent with similar types of construction activities. Ifthe value is woo or more, a
RECORDEDNotiw ofCommencement must be submitted whh ft application.
SLCCDV Form No.: o01-02
L,cFr NZW. oo.C. ,)
"of io . 7. /i
UPDATED mo9
\-AVY..7�y
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AMDMM: OWU QU CA&�AR-- Md
STATE ZIP: 3mil
Email:
IF THE FEg, sua-LE.TrILEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN,,NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER
ADDRESS:
'IC- hil: STATE: ZIP:
.'Ai6NE-o5AYTIMEY.,^' C
CON MACTORINFORMATLFON
Q
-S1-.�,JG-0&4'G2MRT,ff:C&c- isovn m ST. LUCIE COUNTY CERT
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At(
PHONE (D �*YTIME): Q0
BONDING COMPANY:
ADDRESS:
CITY:
STATE:
STATE:
ZIP:
Email: �
M V1
STATE' • 21P:
i
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: ZIP:
E"ORTANT NOTICE: -Whcnla permit'islissued amid it is not picked up within 60 days after notification
it will be voided and returned to you by mail
I cars
CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicercu, and to gbtain 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
worl(wi 1!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, POOIS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC, not otherwise included with this building permit application.
l
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 foil concurreney 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.
—.Arl �i;t5m.:Liar"4.,.'-:.i
OWNER OR CONTRACTOR SIGNATURE
,S'I'ATE'OF FLORIDA �J
COUNTY OF lLl �.J
The foregoing instrument was acknowledged before
me this ay of20 /I
I � 7TT�TTT���
by
who
_or has produced
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
by
of ,/1C�Cl c ' ' .201L
_ or has produced
identification. / I . n ' 1 as identification.
V,gV{{Wi VI L\Y{Yl�
VWNOTARYFPUR��
RACHELCommission No.,�(�STATE Oion No.Comm# DD980007
Expires4/1612014
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERBUH.DER, 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
SECTION
TOWNSHIP
RANGE
MAPNO.
I I C�LJ
ZONING
CC
LAND USE
�X
LOT CVG%
TAZNO.
FLOOD ZONE
FIRM MAP #
IsTFIR 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 111990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
'
AREA
FEE
FEE
LIBRARY
PUBLIC BLD
PUB
PARKS
BRACT
FRACT FEE
ACT
IMPACT
FEE
CORRECTION
FEE
GENERAL
FEE
SCHOOL
ROAD
CREDIT
Y
N
�WACT
1Y": V
BRACT
CI
i.,:.I.
✓
FEE
FEE
FME/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
EMPACf
4i ``--
REQUIRED
FEE
)VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF _
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC, • r • GAS `. , r
"' J
LOT OF RECORD
FEES;
REQUIRED }'
PLUMBING _
FEES
I
DATE SENT TO ADDRESSING:
r
i
REVIEWS
FRONT, 'i
)'-,%ZONING h '
SUPERVISOR
PLANS
VEGETATION
SEA TLE.
;MANGROVE
COUNUR
REVIEW
REVIEW `
REVIEW
REVIEW
REVB3W
REVIEWDATE
RECEIVED
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COMPLETED
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INITIALS
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