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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFtE USE > ' ONLY ,r SECTION: TOWNSHIP: �." RANGE:. MAP NO.: ' ZONING: Q� LAND USE: - n �c/� LOT-CVG %: TAZ NO.: - F[-OOpZONE: FIRM MAP #: %_ P ; 1ST FUR ELV; MAX HGT: ' " CST TYPE: , 1 / - - V OCCPTYPE: . �s: MAX. OCCP: # OF PLRS, WATER: SEWER: SPRINKLERS,. STORMWATE - R LOT OF REC (be fr 1/90) LOT OF REC (aftr 1190) LOT $PLIT LOT SPLIT REQ'D APPRV'D DECAL - NUMBER LIBRARY IMPACT FEE i 5aZ PARKS �p(J, 'P.ERMIT " IMPACT FEE / FEE '- REPORT CODE" ID, PUBLIC BLDG IMPACT FEE HABITABALE r !RADON FEE r- / 5('�//_ //��/, RADON) (AREA ROAD IMPACT ZONE �I� GROSS ROAD IMPACT FEE CREDIT ` \ p) TOTAL ROAD e;IMPACT FEE DUEY �� /J N SCHOOL CREDIT TOTAL IMPACT FEE i ': SCHOOL IMPACT FEE j POLICE FEE FIRE FEE• MISC FEES: TOTAL - M SLC. FEES Y N ADDITIONAL SPECIFY: TOTAL ALL PERMITS - FEES REQ•D REVIEWS ZONING 1.REVIEWEDj3Y ZONING PLANS VEGETATION SEA , f MANGROVE EXAMINING TURTLE DATE COMPLETE + LE I7 D3 - ZQ 7 0 7ho� -3 INITIALS �J � - ,-,taxi^ •y " DATE FILED: PLAN REVIEW FEE: `0 _A9_ RECEIPT NO.: 2 / O PERMTT NUMBER: ALL INFO MUST BE COMPLETE FILLED IN TO BE ACCEPTED v1e ��ay ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE �OR10Q' FORT PIERCE. F34982-5652 561-062-1553 APPLICATION for BUILDING PERT CERTIFICATE of CAPACITY/ZONING COMPLIANCE "IS03- 9sool Crook-ed S-tick 1z,„ PSG 3�(gg�O PROJECT INFORMATIONtkl. } 1. LOCATION/SITE ADDRESS: 3r7,Flo1 3S, eLUE5.S.t1>?_� ( ko ( - rs 2. SID NAME: 3. PROPERTY TAX ID #: SITE PLAN NAME: Cl-u85 to 3� 3isZK- oao-Coco - 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT , BOOK �D �3;�� SCANNED �— BY Sme, SixtZy�`I St. Lucie County 6. PAGE " 7. B CK 8. LOT NO. lb, l� ►$ NO. �7,3�35, 3`E 9. PARCEL SIZE: SO FT. '?7�v3 LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: �ClSTRLtGTcoN t?MLtL-Tl FAMIL_y 11. SETBACKS (ACTUAL) FRONT:GHT / LEFT / fi 99....��������"" © 1 •V SIDE b SID O 12. TYPE OF CONSTRUCTION ( heck all appropriate boxes) 13. 14. 16. .W NEW CONSTRUCTION RESIDENTIAL [ ] OTHER (SPECIFY) [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] COMMERCIAL [ ] INDUSTRIAL DESCRIPTION OF PROPOSED USE:HS1b8AlZ^lPoL Sq. Ft./CONSTRUCTION: la3 15. Sq. Ft. 1st Floor: 3 ] VALUE OF CONS7Rt1CTION• It %Oa n The value of construction Is used to determine the amount of permit fees to be 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 corlsistent with similar types of construction activities. If the value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCC Form No.: 001-02 L1..a CERTIFICATION: OWNER INFORMATION: rr'' NAME'\zs>�i�V� lt�tr�1�S Lz rj L P This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of i capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit ADDRESS: ((op ( �Rlxcq �L,�.C� 5--� god and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that PION separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, ��sr PAS �STATE: L ZIP 33zkQ,i ; TANKS, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application. PHONE (DAYTIME): 1�°iZl '-ilorj (2`l`gq � 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, utility substations & accessouses to another non - BELOW. residential use. THE FEE SIMPLE TITLEHOLDER: N/A NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING ADDRESS: TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN, CITY: FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING STATE: ZIP PHONE (DAYTIME): YOUR NOTICE OF COMMENCEMENT., ( I 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 CONTRACTOR INFORMATION PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. ST.. of FL REGJCERT #: LBG 4C''-1Z>E3 (O ST. LUCIE COUNTY CERT #: BUSINESS NAME:_ JI6h(A-r`. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance QUALIFIERS NAME: 36gT'-RT of VAI L with all applicable laws regulating construction.andzoning. ADDRESS: L l(oU N W 4?$ clOc S-r .hW--c�-1- STATE: FL ZIP 3V48� OWNER/CO OR SIGNATURE CONTRA OR IGNATURE PHONE (DAYTIME): 1�72r 1'NoS - 4•io 3 FAX NO. y �,a3 STATE OF FLORIDA STATE OF FLORIDA //�� ,,,� COUNTY OF S--r LUlG1EK COUNTY OF Sr Luca, ARCHIT/ENGINEER: �lx.'d2t�1 �R p-t�Cb$ \'CSC � �L.6�f�1��L�S The foregoing instrument was acknowledged The foregoing nstrument was acknowledged ADDRESS: t �ZC> �giMO�2A.N eLU�j S l>t'Tl� za3 _ be'f9 re me this OCday o 0 03, b �&_ y 20 R3 , by �, ' 0 y cl�.g�X/I before me th}}'ss day of CITY: bRLtV STATE: �= �p 3�gorjw„o is personally crown to me r who �j�!lr9i • Vw'� o is er nail known ahas produ as identification. r who s produced as identification. PHONE (DAYTIME): {�Of l (p.�g '-FtSt (/� l �� g ture of Notary L2_ i lure of Notary BONDING COMPANY: � �. ADDRESS: J_YAWI: Hoele Ly'(JW6 ttcp, PITY: Type or Print Name of Notary Type of Print Name of Notary STATE: Zip Notary Public Title Notary Public Title MORTGAGE LENDER: CJ/j�. Commission Number Commission Number ADDRESS: Notary LYNNEMOte o Florida -LYNNE MOORE (seal) Ptl. a Stale 23 2003 (seal) .Notary Public, State of Florida My Comm. exp. Sept. 6 c10: STATE: ZIP No. CC87385 My comm. exp. Sept. 23, 2003 Cam' Comm. No. CC873856 NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IMPORTANT NOTICE: When a permit is issued and it is not' picked up within 60 days IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEFVBUILDER, THE OWNER MUST PERSONALLY APPEAR after notification it will be voided and returned to you by mail. TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.: -