Loading...
HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi OFFICE USE ONLY: DATE FILED: I �� y '` Q/ _, I 0 2� BP #; Q�p PLAN REVIEW FEE: RECEIPT NO.: o IS 8 7 PERMIT NUMBER: l��% J CONCURRENCY FEE: RECEIPT NO.: 7 1 S S CERT. CAP. NO.: ALL INFO MIST BE COMPLETE 8L FILLED IN TO BE ACCEPTED .OFFICE USE DNLY:'.:.. SCAiuNED co ST. LUCIE COUNTY PUBLIC WORKS BY SECSION: ____�% TowNSHIP: _ / — _RANGE; L��1� _MgPND.: y� BUILDING&ZONING bEPARTMENT BQ,-�(yeug* T 2300 VIRGINIA AVENUE ���9 /% LAND USE: LOT CVG %: ^TAZ NO.: ' ROp10 FORT PIERCE, F1 34982-5652 ZONING: �[ Se,��-553 r10olio/-o�a� FLOOD ZONE: FIRM MAP #: ,ST FLR ELV: MAX HGT: APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE CST TYPE: OCCP TYPE: MAX. OCCP: # OF FLRS: PROJECT INFORMATION ,!�� WATER: SEWER: SPRINKLERS STORMWATE 1. LOCATION/SITE ADDRESS: L Z D l 0 1 tJ )Zl i---AW AIP 4L� (��i2i �i! LICE/�� /c R 2. S/D NAME: ���' 1 � l - L i� SITE PLAN NAME: �`14 I LOT OF REC (befr,/90) � LOT OF REC (aftr 1/90) LOT SPLR LOT SPLR REO•D APPRVT) I 3. PROPERTY TAX ID #: 4. LEGAL DESCRIPTION (attach extra sheets if necessary): DECAL LIBRARY PARKS PERMIT NUMBER IMPACT FEE IMPACTFEE FEE ' REPORT PUBLIC BLDG .. HABITABALE RADON FEE i 5. PLAT 6. PAGE 7. BLOCK B. LOT CODE IMPACT FEE - AREA BOOK � < NO. 3 NO. NO. (RADON) f ROAD . GROSS ROAD CREDIT Y N TOTAL ROAD I IMPACTZONE ' IMPACT,FEE IMPACT FEE 9. PARCEL SIZE: ACRES/SQ FT. • o 8 LOT DIMENSIONS Z3B, Z�-X I foi, X 39�.y'6'!r!G8 • o DUE 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: S,t15T�1 LL / 2L Y N SCHOOL CREDIT TOTAL IMPACT FEE -� SCHOOL • _ ,% IMPACT FEE I 11. SETBACKS (ACTUAL) FRONT: N BACK: SI' RIGHTS EFT /I//� _ 34•1$ 5' o SIDE SIDE: POLICE FEE FIRE FEE MISC FEES: TOTAL POUCEIFIREi 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) _ MISC. FEES j I NEW CONSTRUCTION ADDmONAL SPECIFY- - - - TorALAu [ 1 EXPANSION/AODI'f10N [ ] INTERIOR RENOVATION PERMITS ['RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL REpp FEES i [ ] OTHER (SPECIFY) I . ) 13. DESCRIPTION OF PROPOSED USE: REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE REVIEWED BY EXAMINING TURTLE 14. Sq. FUCONSTRUCTION: "� 15. Sq. Ft 1st Floor. DATIE 16. VALUE OF CONSTRUCTION: 5 3a CWPUETE a0zlIA&9 O e J The value of calstrudkn bused to determine the wwwU of pemJt Pees to be asseased. SL Wde County tmervos the ftht W questlan wWor modl/y the INITALS Ybirated value of construction If it Is dernantatW mat t e attr fitted ppures ate not coibb0ent with eirnW types of coentrudbn S*Atbs. If tro value Is S2500 or more. a RECORDED Notes of Carmnancement must be subNted with tde aWcatiar. SLCCDV Form No.: 001-02 OWNER INFORMATION: NAME: J /a iL\ r=s C r `1 PL�'%� %(.( 1 ADDRESS: - , .' . ` Z O I c, I U V-,) tLIJ �Jc¢ f� CITY: _. hrPBa -+-Lj, LjlGII�- STATE: /:Z---- Zip i3499`t'A PHONE (DAYTIME): 1 YJ�1 -3 6 3 — 7 0o ,j IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. , FEE SIMPLE TITLEHOLDER: �" ll,1- ADDRESS: CITY: PHONE (DAYTIME): CONTRACTOR INFORMATION ST. of FL REGJCERT is 12 rDD (p & 7r 0 BUSINESS NAME: _ �- D u D ar,.bIsiJj f QUALIFIERS NAME: _ go %Ai-,eT SL©t STATE: ST. LUCIE COUNTY CERT 0: 7 wL So ¢ j ZIP ADDRESS: 'A3 O(, SD 4 t-1 r V S ijr I, CITY: p 0IZ r P) g v , STATE: _ %� ZIP °HONE (DAYTIME): (_ I (o j — Z7 coo FAX NO. 3 1RCHIT/ENGINEER 1DDRESS: :m: 'HONE (DAYTIME): IONDING COMPANY: DDRESS: ITY: ORTGAGE LENDER DDRESS• I Y: " 1— 0,uG14- PJDOF STATE: STATE: ZIP 0 STATE: 21P 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. 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: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 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 PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN 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 compliance with all applicable laws regulating construction and zoning J� NER(CONTRACTOR SIGNATURE NTRACTOR SIGNATURE STATE OF FLORID r STATE OF FLORIDA SS COUNTY OF COUNTY OF �I�t d The fo going instrumen*asidentification. nowlodged The fo ng instrument s cknowledged befor a this 0 kJ by _ efo e c day of by Is pe onallme or who o is p dr►o ran to me he r uce or o h s produ n. 1 Signature of Notary Signature of Notary gksl A-s C-1 9I� Type or Print Name of No Type of Print Name of Notary Notary Public Titlelim E. WEISS N # DD 146900 Nbfary Public Title ember23,2006A'§ .WEISS Commission Nuca&Bm#na.lns Commission N '' � MY caykfiggft# DD 146900 '�'or rLoa EXPI99St5:;5.90fember 23,2006 (seal) (Seal) 1-BOD3.NOTARY FL owy§jMW&Bacng. Im NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. WPORTANT NOTICE: When a permit is issued and it is not picked up within 6O days IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEFWBUILDER THE OWNER MUST PERSONALLY APPEAR fter notification It will be voided and returned to you by mall TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE;FRONT OF THIS APPLICATION. .