HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - FROM FILE - 0711-0242DATE FILED:'
BP
RECEIPT PLAN REVIEW FEE: PERMIT NUMBER:
j
CONCURRENCYFEE: @SD) RECEIPT NO.: CERT. CAP. NO.:
a_
ALL INFO MUST BE COMPLETE u FILLED IN TO BE ACCEPTED
SECTION:
TOWNSHIP:
RANGE:
MAP NO-
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
SCANNED
ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
FORT PIERCE, FL 34982-5652
772-462-1553 BY
St Lucie County
FLOOD ZONE:
FIRM MAP
1ST FLR ELV.
MAXHGT:
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
CST TYPE:
OCCP TYPE:
MAX.00CP:
OF FLRS:
or,- PROJECT INFORMATION
WATER:
SEWER:
- /
dAu
SPRINKLERS
STORMWATER
1. LOCATION/SITE ADDRESS: 0,avxiif-w QwINVe
2. S/D NAME: fp- a SITE PLAN NAME:
.
LOT OF REG (bc Fr 1/90)
LOT OF REG (aftr 1190)
LOT SPLIT
LOT SPLIT
I REO'D
APPRVD
3- PROPERTY TAX ID 16_L_7.'90067t-.
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
-1tod?= OAA)2'b
"T4 6y Q k!�
DECAL
NUMBER
LIBRARY
IMPACT FEE
�
PARKS
IMPACTFEE
I
PERMIT
FEE
i REPORT
PUBUCBLD61
la?.919J
HABITABALE
RADON FEE
CODE
/4,,)/
YEEe
V I
5- .PLAT.6. PAGE 7.- LOT
(RADON)
.BLOCKS.
BOOK -z:7 Uy NO. 09- 45 NO. Un F4-- eVLe NO. t E '5-
GROSS
i*A
IMPACT ZONE
ROAD
IMPACT FEE
DUE
CREDIT
TOTAL ROAD
IMPACT FEE
9. PARCEL SIZE: ACRES/SQ FT. A C4e A LOT DIMENSIONS / 2,� , x-
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
SCHOOL-
IMPACTFEE
CREDIT
TOTAL
vvc de,,-e-
SCHOOL
U
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT
OEM
IMPACT FEE
14*j
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL25.1
LEFT
SIDE SIDE- 30
Al
MIPOSC. FEESLICE/FIRE/
12. TYPE OF CONSTRUCTION (Check all appropriate boxes
ADDITIONAL
PERMITS
Y
N
SPECIFY.
TOTAL ALL
NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION
4 RESIDENTIAL
REQ'D
FEES
COMMERCIAL INDUSTRIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: 4,t-
REVIEWS
ZONING
ZONING
REVIEWED BY
PLANS
EXAMINING
. VEGETATION
SEA
TURTLE
MANGROVE
14. Sq. FtJCONSTRUCTION: 2-fo 15- Sq. Ft. Ist Floor.
DATE
COMPLETE
VALUE OF CONSTRUCTION: $ 30b
The value Of cOnstructiOn is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the right to question and/or modify
indicated value of construction if it Is demonstrated that the submitted figures are not consistent with similar types
INITIALS
of construction activities. If the value is $2
or more. a RECORDED Notice Of Commencement must be submitted with this appljglion.
4
3LCCDV Form NO.: 001-02
DWNER INFORMATION' CXXn
NAME: ��` }�J
maQ -, I
ADDRESS:
F{' 7 �2 �,Q Qc�0Yu07J
LLC
tqr,�-�• ✓a
CITY:. . STATE: ZIP
PHONE (DAYTIME): t t
77Z �[o�• �000
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 REGJCERT #:
BUSINESS NAME: _
QUALIFIERS NAME:
ST. LUCIE•COUNTY CERT #-
ADDRESS: ` 0 2• r:'LQ'aLt"Uw ld-UU-(' -
CITY: STATE:
PHONE (DAYTIME): ( 1 1 -72 - FAX NO.
ARCHITIENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
ry►1FE
MORTGAGE LENDER:
ADDRESS:
CITY:
( ( (I
t ,-287.-733<2�
ri k
P1 &
2(702
c..c
ZIP 3 /�
STATE: F-C ZIP 33 `F�
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.
CERTIFICATION: Jy
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate
capacity, if applicable, for the permitted work- I certify that no work or installation has commenced prior to the issuance of a perr
and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand tf
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATER
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, accessc
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another nc
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYIP
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY- IF YOU INTEND TO OBTP
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDIP
YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THEAPPLICANT FORTHIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE, At
INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS PERMIT Y(
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LII
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 complian
' IT 11 applicable laws regulating construction and zoning-
OWNS /C )NTRACTO G A CON GRAGTOR SIGNATURE -
STATE OF FL STATE OF FLO�IgI� ,
COUNTY COUNTY OF �'i J-ELCL(
The foregoing instrument was
acknowledg d
efo me this -(& day of _ TY, 20 0, by
who is �rsoIT81 v ni—k ov7trta=me
or who'
h pr ced as identification-
..............
Signature of
otary
:
M S _to
10 o
Type or Print Name of Notary
:000 d W 3
W n
Nota`J
ry Public Title
CJ .
:Z
Commission Number
.N `V9-Z
�� a U.
?wn"��:
(seal)
i................i
The foregoing instrument dvas' acknowledged
Tore me this P�— day of i J" 2007 'by
-B&W L who is pe a y no s me
or ho has produced as identification.
'.�+..mouunn.
fl
o�
°0
01 ge
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.,
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERBUILDER, THE OWNER MUST PERSONALLY APPO
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
Signature of Notary
L G6#xkd:
Type of Print Name of Notary
Notary Public Title
(seal)
Commission Number