HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONvN
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OFFICE -USE ONLY:
DATE FILED: S I e13�"j p
PLAN REVIEW FEE: 50 .0 d RECEIPT NO.: I `�1 1 0
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER: I a05 - 03 i
CERT. CAP. NO.:
ALL INFO MIDST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DWISION�1Cn
2300 Virginia Avenue AWYE ./'
Ft. Pierce, FL 34982-5652 �Y�a h.
772-462-1553 St. Lucie Cou6ty
APPLICATION for BUILDING F RMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
I. LOCATION/SITE ADDRESS: 1 d nl b0 S OCeOA D r , PNS P AI &0--a e y.
2. PROJECT NAME: E V: -rK LL. G SITE PLAN NAME: F-f T X LI. C
3. PROPERTY TAX ID #: Ll J I2 - 3) - G'U o 2 - acro !j
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 0-'V k e' -q'7 U I
/7-3�gj �,y IRbt 1,f NLY y3o' A s mElas f1L.G RlH' o-F Gov-rLur7-V&
5. PLAT BOOK 6. PAGE NO. /— 7. BLOCK NO. - 8. LOT NO. - 0
9. PARCEL SIZE (ACRES/SQ FT.): 1 t `O S T LOT DIMENSIONS: —
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
-r rv5 ra��rzi�N o� 57AN0 -9y G (P64U,T-!z 51-C i302-
��y151aN of I.OLA'f/DnJ t pllLM�r I=oR PRlJ '6C-Aa)
11. SETBACKS (ACTUAL) FRONT: N/F} BACK: N(/i RIGHT SIDE: 4_ LEFT SIDE: N o
12, TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [v] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) GUV u/L�4 YDR -XA/ 5 TR L H' TI o N
13. DESCRIPTION OF PROPOSED USE: NO 4�d &- G C.IVGt li I G 2
14. SQ. FT OF CONSTRUCTION: _I O .151 /1 15. SF. FT 1st FLOOR
16. VALUE OF CONSTRUCTION: $ P/-30 O1V4-Y -- 0 / 5O0
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 consistent with 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
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UPDATED 6/25109
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OWNER IRIF®Il MATOON
NAME: L L
ADDRESS: / 66f e-0 0 u-t &Ceoru Of.
CITY: 7\r4se rj STATE: 1� L ZIP:
PHONE (DAYTIME): (7?2 6% 6%& Email:
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: STATE: ZIP:
PHONE (DAYTIME): L�
CONTRACTOR INFORMATION q
ST. of FL REG.CERT #: C GC{33 75 6 7 ST. LUCIE COUNTY CERT #: Q15 -sl
BUSINESS NAME: tT-Q H NQ U P D Y
QUALIFIERS NAME: _;JO AA) QVR P
ADDRESS: / V. 6 5alD oi Li_
CITY: V c-" 'C G STATE: 1e L ZIP: 32 9 6S
PHONE (DAYTIME): CIX) '1 7 3 "!U 4 Z FAX No. 7 72 - 9 7B- `i365 Email:
ARCHIT NGINE . M L. C- iV(, I "6 S IR t A; G -r iJ C
ADDRESS: 2.03v 37+h AVE.
CITY: 1f G ILD fh I- Ii 1 STATE: I L ZIP: 3 z9 6 a 2'14 9
PHONE (DAYTIME): CL7Z 5 6 Q- 12 5 7
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP:
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: ZIP:
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.
i l S
1 i i f
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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OW E OR CONT OR SIGNATURE
COUNTY of oRT1/A„`Pv ep
The foregoing instrument was acknowledged before
me this 4 uAay of 20 % 3
by PfirCRY C., cl Gt ✓Rl
who is personally known _
or has produced
4I(4ir&t3 4'.1C
sidentitiction.
Signature of Notary
MRBARA A MALEK
Commission No.
MYCOMMIS�19SWI63419
EXPIRES: April 30, 2016
OFh&op
Bondedltuu Budget Notary Saviors
COUNTYoFLORIDA,
O ) MBMW R)Vgk
The foregoing instrument was acknowledged before
�B
me this "y of 20/,
by T0140 V . Yvft0'�
who is personally known _ or has produced
wza-7�A_v
ation.
Signature of Notary
?otrn;?o¢c RARRAM A.MALEK
Commission No. C0MMISS*igtI63419
EXPIRES: April 30,2016
OFFUd Balled Tluu Budget Notary Semces
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 APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE' FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit arllecklist.
OFFICE USE ONLY BP #: 1 z 0 5- 03 y l
SECTION
-� ^
TOWNSHIP
J,
RANGE
(A
1
MAP NO.
Ll 5
ZONING
L
LAND USE
co
LOT CVG %
TAZ NO.
v
FLOOD ZONE
t
FIRM MAP #
I '
11T FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF KE
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
1
AREA
FEE
FEE
O
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS -
IMPACT
IMPACrFEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING _
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
. /
DATE
YZA 13
oG 47
COMPLETED
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