HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�*- 16 M M1 �
SECTION:
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
Palo
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
/4k
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
t/bo
SPRINKLERS
STORMWATE
R
LOT OF REC (befr
1/90)
I
LOT OF REC (aftr 1190)
V/
LOT SPLIT
LOT SPLIT
REO'D
APPR\rD
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACTFEE
FEE
REPORT
CODE
j
PUBLIC BLDG
IMPACT FEE
HABITABALE
AREA
RADON FEE
13 (S 2-y
(RADON)
Y N
ROAD
GROSSROAD
CREDIT
TOTAL ROAD
IMPACTZONE
IMPACIfffF
IMPACTFEE
DUE
Y
N
SCHOOL
CREDIT
TOTAL
IMPACTFEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICEIFIRE/
—1
MISC. FEES
ADDITIO NAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
FZEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWEDBY
EXAMINING
TURTLE
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO .: au?WPERMIT NUM13ER:
ALL INFO MUST BE COMPLETE ar FILLED IN TO BE ACCEPTED
SGANNF-D
ST. LUCIE COUNTY PUBLIC WORKS BY
BUILDING & ZONING DEPARTMENT St. Lucie Comb
2300 VIRGINIA AVENUE
FORT PIERCE, FIL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
5C'�C1'5v%0+.C;t
1 LOCATION/SITE ADDRESS: 89 q6 — eRS4
2. SID NAME: "PC—k QLLL"9: SITE PLAN NAME: CA!S-TLIF-� X>wsars
3. PROPERTY TAX ID #: -I - coo - Coco - C>CX�1/3
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT. 6. PAGE 7. $CKTtL%t> >0 8. LOT
BOOK NO. _ (Z. NO. 149
9. PARCEL SIZE: y,-�o
LOT DIMENSIONS 06,YX
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
A �
2t�ft 8 UN �T- M Lk L-n V-A�tA (L%q
rCK: ' 1 q--M
11. SETBACKS (ACTUAL) FRONT: &A RIGHT -5 LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
X NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION
RESIDENTIAL COMMERCIAL INDUSTRIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: �5; 1&'zAX 15. Sq. Ft. 1st Floor: e.'
16. VALUE OF CONSTRUCTION.
The value of construction is used to determine the amount o permit fees to be assessed. St. Lucie County reserves the right to question an r m e
Indicated value of construction if it Is demonstrated that the submitted figures are not consistent Wth 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
CERTIFICATION:
OWNER INFORMATION:
NAME: RV-Sa1R\3IE 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
ADDRESS: �>LA C-T=- 1�,z 0 ITV- E�0� and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that
CITY: �>Au\-% le>FAC-k� STATE: fFL- ZIP t��e40 I 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.
PHONE (DAYTIME):
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS structures (all types), swimming pools, fences, walls, signs, screen rooms', ufility substations & accessory uses to another non -
BELOW.
residential use.
FEE SIMPLETITLEHOLDER:
ADDRESS: 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
CITY: STATE: Zip FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
PHONE (DAYTIME): YOUR NOTICE OF COMMENCEMENT.
CONTRACTOR INFORMATION
ST. of FL REGJCERT 9: oc> S 42�. ST. LUCIE COUNTY CERT 9:
BUSINESS NAME: A7 I L 1-4 � P-
QUALIFIERS NAME: ROI�MKR-T, I U41 L-
ADDRESS:
CITY: STATE: ZIP %4ACta<1P
PHONE (DAYTIME): 44'?C>-'S FAX NO.— L4e�s 460-:3
ARCHITIENGINEER: sf-53-y 1> Mpg
—1 S-Z-Z- 1311-LA
ADDRESS: Cj +
CITY: STATE. ZIP -a-
PHONE (DAYTIME): i /�141
BONDING COMPANY:
ADDRESS:
CITY: STATE: Zip
MORTGAGE LENDER:
IkDDRESS:
-ITY: STATE: ZIP
IMPORTANT NOTICE: When a permit is issued and It is not picked up within 60 days
mfter notification it will be voided and returned to you by mail.
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 co t ti d g.
-- D
s ATURE
OWNERVC D%NTOR SIGNATURE CONTRAsim�sIGN
STATE OF FLORIDA
COUNTYOF S;T L-UctlR-
The foregoing instrument waE
be
f, Wre me this 2g!%y of
��k &22
is�erso-n—aily-li;To-
has pro ced as
ig ture of Notary
,Lt-11A11AU9 MOD 09
Type or Print Name of Notary
Notary Public Title
acknowledged
2QL4 by
i ro-m—Dor who
STATE OF FLORIDA
COUNTYOF!S-r' Z-L�iM
The foregoing insyument was acknowl
b lb a me t,his 40day of S�� , 200-
c
�rodu
ro
' 0-1L Zho IS perMnally known
v
o who produced _ as identiffi
ig
g re of Notary
Type of Print Name of Notary
t1gtary Public Title
S'Ommissl NN mmo RE 858 Commission Number
007 LYNNE MOORE
(seal) Ires (seal) Comm# DD0232858
sonded1hr (8 ) n., Inc. Expires 9/23M007
M�ri,IA Bonded thru (800)432-4254
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BEf _f&da Nota!y Assn., Inc.
IF APPEYING FOR THIS BUILDING PERMIT AS AN OWNEFVBUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.