HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBP #: D'I- 09,8,1
OFFICE .USE -ONLY
SECTION:.
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
rS
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER: .
SPRINKLERS
STORMWATE
R
LOT OF REC (bet 1/90)
LOT OF REC (aftr 1l9D)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLDG
".
HABITABALE
RADON FEE
CODE
-
-
IMPACTFEE
AREA
1
1
(RADON)
-
Y
N
ROAD
ROAD
CREDIT
TOTAL ROAD
IMPACTZONE
;GROSS
PA
IMPACT FEE
'
Y
N
SCHOOL
CREDIT
::
TOTAL
IMPACT FEE
SCHOOL
IMPACTFEE
POUCE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA ->•-..
MANGROVE
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DATE
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INITIALS
OFFICE USE ONLY: _
DATE FILED: I —
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MAST BE COMPLETE 8t FILLED IN TO BE ACCEPTED
��e oGy ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
'20RIOP FORT PIERCE, FL 34982-'5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION SCANNED
�+ BY
1. LOCATION/SITE ADDRESS: �%o� D3 of . L ii �Q17 &/m l Jy lye St. Lucie County
I -
2. S/D NAME: l VI? Y) SITE PLAN NAME: l%! ✓.4Nl
i 3. PROPERTY TAX ID #: 3so?- 30? 3 - QOp a - OOQ- 1
i4. LEGAL DESCRIPTION (attach extra sheets it necessary):
5. PLAT 6. PAGE 7. BLOCK '8. ' LOT
BOOK i/
O. NO. 7
9. PARCEL SIZE: ACRES/SQ FT. LOTDIMENSIONS �69.d8� X SPo/Y jta9u x 789.s>s�
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
n )r s. oc1 l Ja r,K 3 41 V U� [
11. SETBVACKS (ACTUAL) FRONT: r BACK: yl 1 ' RIGHT
Nth � SIDE /%d 1
LEFT /
SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[y] 'RESIDENTIAL [ ] COMMERCIAL (] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED U�u,S��E11: .Xgdtee-47'1,IwA L r ^
14. Sq. FUCONSTRUCTION: � 15. Sq. FL 1st Floor.
16. VALUE OF CONSTRUCTION: $ 31, 3 %ay
The value of construction Is used to determine the anatmt of pemdt fees to be rinsed. St Wde Canty reserves the A9ht to question and/or modify the
Indicated value of mtstriration 8 it is denarntrated that the submitted flpures are not oogsistent with similar "as of mtshudbn advl8ea. R the value Is S2500
or more, a RECORDED Notice of commencement must be suwnmed with this 2WIca6om.
SLCCDV Form No.: 001-02
l
OWNER INFORMATION: ,jj��
NAME: /.-'I z D n 1
ADDRESS: rAD T
CITY: r-4- r' f Le`r O
PHONE (DAYTIME): rnfuI 33a - 3 78 d
STATE: 5-
ZIP 3 qaR%
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):
STATE:
CONTRACTOR INFORMATION
ST. of FL REGJCERT 9: CPC ��5 �33 p
/� f ST. LUCIE COUNTY CERT N:
BUSINESS NAME: 1 Oct is % % G (2 ft oe-
QUALIFIERS NAME: 1 -errV 1k) LK
pT
ADDRESS: ME S fe q0e4
QP J�
CITY: _ Art P Ly-sr-. L(l G e-.
PHONE (DAYTIME): 177d1 3 37-Q?!'�
kRCHITIENGINEER:
4DDRESS:
:fTY:
PHONE (DAYTIME):
IONDING COMPANY.
:ITY:
7dos "GLys'r
Po r2 t s (-L 4 e/ e-
11)A 'V4 P -5 5G 9
IORTGAGELENDER: .✓iil%�-
,DDRESS:
try:
ZIP
a? 8'-3 7/
STATE: ��' 21P • . $
FAXNO. 7ioi-��7= �7 .
F.ve�Lf, otl v
STATE: r f' 21P
STATE:
STATE:
ZIP
tdlj
CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certific
capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a i
and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understan
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEAL
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, acce
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PA
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OE
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOR:
YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT. TITLE,
INTEREST THAT IS SUBJECT TO ATTACHM NM AS A CONDITION OF THIS PERMIT
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION
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 compli
/� with all applicable laws regulating construction and zoning.
p ( i rl 9
I l� QQ .Ax nTy � � ,-.. �. y ,-
t �O�WNER/�/CONTRACTORcSIGfVAYURE �CONTRACTrIGNXTURE
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 57-LZ44E COUNTY OF St-Lua✓r
The foregoing instrument Was ackn wledged
before me this /D day of fe—t' , 2d, by _
13 �, LLd(wwtl0 is personally known to me or who
has produced FL.77, 1*/_S as identification.
Signature of Notary
Type or Print Name of Notary
MPORTANT 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.
The foregoing instrument was acknowledged
before me this /D day of 20 /� L. by
>< who is p .MgDallT own to me
or who has produced as identification.
r
Signature of Notary
/01
Type of Print Name of Notary
Notary Public Title Notary����P(/ublic Title
aff— a Commission Number ILF `commission Number
(Sea )--`i` ECKE(ti (seal)MARIE E.
State or
, FKa
o` c c Notary Pubft
My Comm. Expires Dec t6. 2016 MARIE E. ECKERT
EE 659669 Notary Public - State of Rome
NO
=r SlCilblTi3 IRED. EACH SIGNATURE M 13 v'� Expires oec 16, 29t6
I�" I BUILDING PERMIT AS AN OWNEUI 56569
I N THIS APPLICATION IN THE OFFICE LISTED ON THE F O N
.Y APPI