HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBP #: -2KOIO;:�'7f
FINACE
USS
. .
.... . ....
2
MAP NO.:
!WZAr
,ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP 1P.
1 ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINK ERS
STORMWATE
R
-
LOT OF REC (befir 1190)
I
LOT OF REC (afir 1190)
I
I
LOT SPLIT
LOT SPLIT
-
RECI'D
APPRV`D
DECAL
LIBRARY
PARKS
iga?_Md
PERMIT
NUMBER
IMPACT FE94
IMPACT FEF-4
FEE
REPORT
PUBLIC BLDG
HABITABALE
RADON FEE
�771
CODE
IMPACTIFEE
AREA
(RADON)
Y N
ROAD
GROSSROAD
CREDIT
TOTAL ROAD
IMPACTZONE
IMPACTFEE
d
IMPACT FEE
DUE
SCHOOL
CRE DIT
TOTAL
IMPACTFEE
SCHOOL
49
IMPACTFEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIREI
MISC. FEES
Y
N
Cot
ADDITIONAL
SPECIFY,
TOTALALL
PERMITS
FEES
REaD
FZIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MAN
R
REVIEWED BY
ING
EXAMIN—
TURTLE
INITI S
DATE FILED: /' &3.
PLAN REVIEW FEE: 442LI V-2 RECEIPT NO.: M-Ift PIERART NUM13ER:
ALL INFO MUST BE COMPLETE at FILLED IN TO BE
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING &ZONING DEPARTMENT
2300 VIRGINIA AVENUE, SCANNED
FORT PIERCE, FL 34ga2-55521,
561-462-1553 BY
St. Lucie CountY
APPLICATION for BUILDING PERNUT
CERTIEFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATIONISITE ADDRESS: 81116- CftAznoLA-S'-rtr� Pb%=-a 95L �) 97j�
2. S/D NAME: C-,A- SITE PLAN NAME:
3. PROPERTY TAX IQ. #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT 6. PAGE 7. BL,90K c 8. LOT
BOOK NO. NO. L41
9. PARCELSIZE: aCREq!� LOTDIMENSIONS % 1461B
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
kiaw MIAL:rk Y tj C'17�
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
1-�>0 SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
.N- NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION
RESIDENTIAL COMMERCIAL INDUSTRIAL
OTHER(SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: I-z-" 9 a-a6
15. Sq. Ft. I st Floor:
�/'s
16. VALUE OF CONSTRUCTION: 0301�11oo
The value of construction is used to determine the amount of permit fees to hA 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 vAth similar types of construction activities. Ifthevalueis$2500
or more, a RECORDED Notice of Commencement must be submitted Wth this applicdUon.
SLCCDV Fonn No.: 001 -02
OWNER INFORMATION:
NAME: L� 1>
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): (1112)
I
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):
CONTRACTOR INFORMATION
STATE:
ZIP
ST. of FL REGJCERT M
C�'AZ>S(C>
ST. LUCIE COUNTY CERT M
I
BUSINESS NAME:
L--r '—=A V,
t-t A-V Lsazt, S_�
Rc:�F_rs
QUALIFIERS NAME:
'15111501-r
VAIL
ADDRESS:
N
R>asP_R\_irP
-T--RA,_-a_
CITY:
ls-r
Lw__t W'_
STATE:
FL_ MP
PHONE (DAYTIME):
(77� —
4-70-3
FAX NO.
LIZ06 — LI, 611a
ADDRESS:
k
T3LO5
!&LnT-E Zb-�'
CITY:
STATE:
—JVZL. ZIP
PHONE (DAYTIME):
/,S8
41-S-1
BONDING COMPXNY:
1A,
ADDRESS:
CITY:
STATE:
7JP
MORTGAGE LENDER:
IkDDRESS:
UITY:
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.
OWNERXONTFIACT�!�IGNATURE CONTRACTOR%iWATURE
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF 'S.r LJAC-liff COUNTYOF-s:rr Lv,=.t
1he foregoing instrument was acknowledged The foregoing instrument was ,
ef re. me this ay oi`:A�, 20k�f by
before
,,� �ez.IJEJ96ay oG�
Iva who is personaIIMnTta221p9)or who 6-1 &Wn- is ne Shnallt
he pro 5d as identification. or who h rod�ced as
Lure ol Notary Si lure of Notary
"a tio LwJkLeF jqaa��
Ty'pe or Print Name of Notary Type of Print Name of Notary
- Notg!y Public Title
Notary Public Title
—Corn C0mm;;__
_lYNNE MOORE
Comm# DD0232858
(seal) (seal) Expires 9=2007
Bonded thru (8100)432-4254
Ea Florida Notary Assn.. Incl
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH 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.