HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOF ICE LE �
DATE FILED: rr --
PLAN REVIEW FEE: RECEIPT NO:
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.:
•75 0 — A
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE-REGUI:ATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING
1. LOCATION/SITE ADDRESS:
2. PROJECT NAME:
3. PROPERTY TAX ID #:
4. LEGAL DE1SCRIPPTCa
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PROJECT INFORMATION b 7I UQ—Vp�J
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SITE PLAN NAME: .SCANNFD
i 8D I bb'7 4 000s BY
if nec/ne�ss'ary : UT (R 5 St. Lucie County
4- 1�1LA, 1ANt l
5. PLAT BOOK_ 6. PAGE NO. _
9. PARCEL SIZE (ACRES/SQ FT.): e 13
10. COMPLETE DESCRIPTION OF
11. SETBACKS (ACTUAL)
12.
13.
Ira
7. BLOCK NO. 8. LOT NO.
LOT DIMENSIONS: 1215X 15Z7
PROJECT OR WORK ACTIVITY:
BACK L4 RIGHT SIDE:'�0t LEFT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION
] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE: t\j'e� S
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
14. SQ. FT OF CONSTRUCTION: "-)!�016 15. SF. FT 1st FLOOR: 3 $a
1 16. VALUE OF CONSTRUCTION: $ a —1 � t � 0 ' (96
The value of construction is used to determine the amount of permit fees to be assessed. $t. 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 Form No.: 001-02
UPDATED 6/25109
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OWNER INFORMATION
0-i 1 (y).10 I/ I, JI
NAME: �,1 P.O I I K!C'r— t-rz;;, 1,
ADDRESS: Sa 2 Cf-oss C'�ee k Ckc' J'Ri 2 Q
CITY: Co �A-sj. Y-� STATE: i ✓ ZIP: 3Z96y
PHONE (DAYTIME): 77Z) 6A61i - 7000 Email: 1>/ A
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): C
CONTRACTOR INFORMATION
ST. of FL REG.CERT�#//: C CSC ( 1 q 1 1 3
BUSINESSNAME: fi . ''O/gZO� /�o5-v '
QUALIFIERS NAME: V ie-n A • L'
CITY: ViXz-'k -�>+ LucLj� II STATE:
PHONE (DAYTIME):�M Z60I - FAXNO.
ARCHIT/ENGINEEK % .A V --�>1 otiMJJ I P t
ADDRESS: T�iI I e'4-a k
CITY: A p, 14' STATE:
PHONE (DAYTIME): C_)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
ST. LUCIE COUNTY CERT #: �) IO_ 1 0-
. / ' ZIP: 5 I 1 11 W
- ui[.I- -- mail: KUSa I O C�ll 2) I
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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.
I
CERTIFICATION:
This application is hereby trade 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, BEATERS, 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 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.
OWNER OR CONTRACTOR SlqNCONTRACTOR SIGNAT
STATE OF FLORIDA 1- n STATE OF FLORIDA r
COUNTY OF IL7 w1 0 � COUNTY OF C '
The foregoing instrument was acknowledged before
f�
me this _� day of �/!' � 20 'L
who is personally known _ or has produced
identification.
Signature of No
y+ Notary Public State of Flodda
Commissio $. David Pooletli (Seal)
s My Comm ssion EE07.3014
01 M1°� Fxpires 0910=014
The foregoing instrument was acknowledged before
me this 17- day of J/�`�' 120 11--
by 1 ��
who is personally known _ or has produced
as identification.
Signa ure of Notary
_. r . state of Floti ft ._
Aros 0sitiv 014
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATU UST 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.
1
A
OFFICE USE ONLY BP #: is 1 • oar?
SECTION
TOWNSHIP
C
RANGE
a'/ e
MAP NO.
7
1
ZONING
LAND USE
�rJ
�J
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
ITT FLR ELV
HGT
CONSTTYPE
OCCUPTYPE
CCUP
#OFFLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
1
HABITABLE
AREA
(RADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BID
IMPACT FEE
CORRECTION
PUBIC BID
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
VARIANCEFEE
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
1•
DATE
COMPLETED
INITIALS