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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONaP e 'ME .�`'" fq 3S ifr.E>£ . SECTION.'- - /�L - TOWNSHIP -' �G RANGE:.. _. :MAP NO.: :. ZONING: % LAND USE:/ / LOT CVG %: TAZ NO.:.,• .. ._ (/�� ... FLOOD ZONE: FIRM MAP #: 1ST FLR ELV: MAX HGT:... - CST TYPE: OCCRTYPE MAX. OCCP: _,- : " _f # OF FLRS: WATER ' _. _. ,. SEWER - .. . SPRINKLERS - _ �. _ .. STORMWATE .. ... - - -) .. ." R . .. LOT OF REC (befr 1/90) - _ LOT OF REC (affr 1/90rr LOT SPL- — " - LOT SPLIT REQ'D APPRV'D DECAL LIBRARY "" PARKS NUMBER IMPACT FEE IMPACT FEE FEE REPORT `� PUBLIC BLDG HABITABALE RADON FEE"- CODE ��n - IMPACT FEE AREA (RADON) ROAD GROSS ROAD CREDIT Y N 'TOTAL ROAD ' IMPACT ZONE IMPACT FEE ' IMPACT FEE DUE Y N SCHOOL CREDIT a Sc.....,. at .. s:s^+t. TOTAL IMPACT FEE d:::::3. a%.w'',^,<.ar;';n^,:, x...�:stT.<7:a'f.:>»;w:�<:. _�_»V. -SCHOOL IMPACT FEE POLICE FEE - FIRE FEE MISC FEES. TOTAL ' POLICEIRRE/ ' MISC. FEES ADDITIONAL SPECIFY: PERMrrS PERMITS TOTAL ALL - REQ'D S FEES . : REVIEWS u - ZONING ZONING PLANS - '' " ` VEGETATTEA MANGROVE " REVIEWED BY EXAMINING ` �'- '_ ' RTLE DATE - COMPLETE 7 av'i D o�3 D• , :' .. ._,� e� INITIALS i OFFICE USE:ONLY: p DATE FILED: p PLAN REVIEW FEE: RECEIPT NO.: O t PERMIT NUMBER:'`' CONCURRENCY FEE: RECEIPT NO.: CERT..CAP NO.: " ST. LUCIE COUNTY PUBLIC WORKS NDL d y� BUILDING &'ZONING DEPARTMENT ' 2300 VIRGINIA AVENUE - ":'1 . i-' '20RtOP :. .,.:..:�.•. _._,...... .... .. _.. • .FORT PIERCE. FL 34982-5652 _ (. 561.462-1553 APPLICATION for BUILDING- PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE SCANNED PROJECT INFORMATION BY. ! I StlucieCounty f 1. LOCATION/SITE/ADDRESS: �+ elenly //. 2. S/D NAME: COQSTi¢L COees SITE PLAN NAME: %3rQCe1G 44a 3. PROPERTY TAX ID 4. LEGAL DESCRIPTION (attach extra sheets lfinecessary): Loi 1z C OC1S%9L C Dl/E� 4; r 5. PLAT 6. PAGE 7. BLOCK 8. LOT BOOK /qtj NO. 35f NO. NO. a i 9. PARCEL SIZE: ACRES/SQ FT.' LOT DIMENSIONS //5X/00 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 1267Wucr �o©/ 1 K c C'o c 11. SETBACKS (ACTUAL) FRONT: BACK: �/ RIGHT ���/ LEFT SIDE y!�/ SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL ] C MMERCIAL _ j ]' INDUSTRIAL [ OTHER (SPECIFY)00 G /n�� 13. DESCRIPTION OF PROPOSED USE: I&e-2eQ.T/O/V — f 14. Sq. Ft/CONSTRUCTION: I:V75. Sq. Ft 1st Floor. 16. VALUE OF CONSTRUCTION: $ ,Q.3, UDO' The value of construction is used to determine the amount of penult fees to be assessed. SL Lucie County reserves the right to question and/or modify th p 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 $250 or more, a RECORDED Notice of Commencement must be submitted with this application. a SLCCDV Form No.: 001-02 THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS "IS TEN (10) WORKING DAYS OWNER INFORMATION: ^yam �q��7 _ NAME:- JorGL "t'Jrtt�.i1. /lr%JL �...-�il ADDRESS: CITY.,-., �1 EIZCt!� STATE•L LP J PHONE (DAYTIME): IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEA BELOW. SE FILL IN NAME AND ADDRESS FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: - STATE: yp PHONE (DAYTIME): f CONTRACTOR INFORMATION ST. of FL REGJCERT:X �! `�'0OD5n']Lq) /I BUSINESS NAME:- �DOlS - 64 nie! QUALIFIERS NAME: : - n pp - ADDRESS: a6FSU- +�,i UIS'"! I CITY' r1^tI�� sT • (. L.i ilil Li PHONE(DAYTIME): ((!I•/_rZ) $3r/-q71 ARCHIT/ENGINEER. ADDRESS: gym: 'HONE (DAYTIME): 3ONDING COMPANY: ADDRESS: :ITY: AORTGAGE LENDER- \)DRESS: ST. LUCIE COUNTY CERT #: LIIPn&i1� 0 STATE: FL ZIP .. •J I7 5 •? FAX NO. _ CERTIFICATION: This application is hereby "made to obtain a permit to do the work and Installations as indicated, and to obtain.a.cert)figte o pPaclty, if applicable, for the permitted work I certify that no work or installation has commenced prior to the issuance of a -- and that all workwilfbe performed to meet the standards of all laws regulating construction in this jurisdiction: I understanpqrmi d-tha 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 ._ ... 9 Permitapplication. The following building permit applications are exempt. from undergoing a full concurrency review: room additions, accesson 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 OBTAIt r Y FINANCING, CONSULT WTH YOUR LENDER OR AN ATTORNEY BEFORE RECORDINC YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT ITL AN[ INTEREST THAT IS GI IBJ T TO AIEA HM NT- AS A CONDITION OF THIS PERMIT YOL _. PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIE? LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECTTO.ATTACHMENT. OWNER'S A FIDAVIT: I Certify that all the foregoing information i a rate and the all work will be done in compliance I-with all applicable laws regulating cons on and zoning / STATE OF FL Q�I COUNTOF J I CLJ� The foregoing instrument as acknowledged STATE: 1 ZIP before me thi �Q da - y qq 1 I who ' ersonall kno n e or who J has produced a� entification. Signature ofofLN~otary La1�lc STATE: • cep Type or Print Name of Notary - u . Notary Public Title Commission N STATE: aP MPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days tfter notification it will be voided and returned to you by mail. '4USIGNATURE STATE OF FLORIDA COUNTY OF The foregoing �i strumen as acknowled "fore a this day o En. byo ' person Ily knowe Yature o has p duced of Notarvi -Type-of Print Name Notary Public 2� 6u Ol 133 a'�r'` Dana L. Laine Cammissi�....... - (seal) t C_ommMion # DD389133 (seal) u �j .Expires November4, 2008 041p1�tAC7tln-Ceusppq hIG BWSAS1 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 APPEAI TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.