HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBP #: o?iO8 4"5
OFFICE
USE ONLY
SECTION:
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TOWNSHIP:
[RANGE.
/
MAP NO.:
ZONING:
LAND USE:
/N
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP A
1S R ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (a&
1/90)
LOT SPLIT
LOT SPLIT
REO'D
APPRV'D
DECAL
_
LIBRARY
PARKS
P IT
NUMBER
IMPACTFEE
•
IMPACT FEE
FEE
REPORT
PUBLIC BLDG
HABITABALE
RADON FEE
CODE
IMPACTFEE
AREA
(RADON)
ROAD
GROSS ROAD
CREDIT
Y
N
TOTAL ROAD
_ IMPACT ZONE
: IMPACTFEE
-
IMPACT FEE
DUE
Y
SCHOOL
CREDIT
'
TOTAL
IMPACT FEE
- -
--:
SCHOOL
IMPACTFEE
POLICE FEE
FIRE FEE
MISC FEES;
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
' '
TOTAL ALL
PERMITS .
FEES
REO'D
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA.
MANGROVE
REVIEWED BY`
EXAMINING
TURTLE"
DATE
COMPLETE
INITIALS
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I
OFFICE USE ONLY:
DATE FILED: Z 61
PLAN REVIEW FEE: RECEIPT NO.: PERNHT NUMIBERt4OSDOV
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
�t6 BOG ST. LUCIE COUNTY PUBLIC WORKS
y� y` SCANNED BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
�j0p10 BY FORT PIERCE, FL 34982-5652
St. Lucie County 561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
01
LOCATION/SITE ADDRESS:
S/D.NAME:
3. PROPERTY TAX ID #: 451"d-COI
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT
BOOK
6. PAGE
NO.
9. PARCEL SIZE: ACRES/SQ FT.
SITE PLAN NAME:
\
.Qr7XJ�rd-�O
,
8. LOf
7. BLOCK
NO.
NO.
LOT DIMENSIONS
3V.9S'7
DESCRIPTION OF CONSTRUCTION -PROJECTOR WORK ACTIVITY:
LCmN�/ �odC.eP El�P4le'e' �!4 w� sr GG CEST
SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
SIDE SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
14. Sq. Ft/CONSTRUCTION: 15. Sq. Ft 1st Floor.
16. VALUE OF CONSTRUCTION: $ v2D{ 000 •coo
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucia 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 similarlypes of construction activities. If the value Is $2500
or more, a RECORDED Notice of Commencement must be submitted with this applica8on.
SLCCDV Form No.: 001-02
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME: -t//64A DcL .Smt Te4.0414D csAle"A4 Assee,
ADDRESS: agoy S Dc�i�✓ ✓.¢..•
CITY: ✓EAACF ✓ STATE: -- zip �iL9cf`7
PHONE (DAYTIME):
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.
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW. The following building permit applications are exempt from undergoing a full ConCUITemcy feVlreview.- roOri additions, accessory
structures all ( types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non -
FEE SIMPLE TITLEHOLDER: residential use.
ADDRESS: NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
CITE: STATE: ZIP TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
PHONE (DAYTIME): i YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT. AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT. TITLE. AND
CONTRACTOR INFORMATION INTEREST THAT IS SUBJECT To ATTACHMENT, AS A CONDITION OF THIS PERMIT YOU
4 `(,n� PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN
ST. of FL REGJCERT #: " C. COS �6 ST. LUCIE COUNTY CERT #: II��D�_�/ LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
BUSINESS NAMEL[TF 6r,JEAJ C.. O�t1S kGT7O,L.1 S fLdIC -S -
QUALIFIERS NAME: JO��' 14 TC-E.D 0 OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
ADDRESS: / 30o Al, ems, 1-tA71go ' Sr a with all applicable laws regulating construction and zoning.
CITY: W P 13 STATE: /L ZIP
PHONE (DAYTIME): r.Jriv/3�- 730b FAX NO. J`lP7^ /`fj''� 32--�/l///A.oy i :1Lj2v—
STATE� F /CONTRACTOR SI �ETRACTOR SIGNATURE
OF FLORIDA / STATE OFF RIDA
ARCHITIFENGINEER: /C.Kd 7-NY COUNTY OFCOUNTY OF
ADDRESS: 36c���iDeoSA�.2rry �j9ieFiS 7 Sr i,' The foregoing instrument was acknowledged The foregoing in trument was cknowledged
�
CITY: • NO �"K I%A9 r 4-r/L STATE: e� ZIP ,334ebe before me this a day of 20/ by _ be re me thjs day of 20_QL by
D who is personally knoWn to me or who who is mmo ally known to me
PHONE (DAYTIME): ( 37A FS-J ' has produced as identification. or who has prod ced as identification.
f�
Ceu
BONDING COMPANY: 49tre of Notary Signatu f Notary
ADDRESS: L--O"/'`�eE S• 7,e.JE�3 G�A�,ggpqB Thallygee Femandez
.-'CITY: STATE: • ZIP Type or Print Name of Notary Type of rl t Name of Notary =°� oCommiWon # CC 759756
Expires July 16, 2002
Notary Public Title Notary Public Title��OF;9' LANTIrBONBDND NEDTHRCA., INC.
MORTGAGE LENDER:
Comrni 1 "• mber Connie s. rowers Commission Number
ADDRESS: h. oY MYCOMMISSION# DD029934 EXPIRES
' May 30, 2005
CITY: STATE: ZIP
(seal) BONDEDTHRurROvFAIN eSURANC&WC (seal)
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.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAF
_TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON'THE FRONT OF THIS APPLICATION.