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Home My WebLink AboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY BP #: SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 15T FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF RFC Before 1/1990 LOT OF REC After 1/1990 LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT -CODE HABITABLE AREA (RADON) RADON FEE PERMIT FEE LIBRARY IMPACT FEE - PUBLIC BLD IMPACT FEE CORRECTION PUBIC BID IMPACT FEE GENERAL PARKS IMPACT _ FEE SCHOOL IMPACT FEE ROAD IMPACT FEE ..• -- yr- CREDIT -"Y N LAWENF IMPACT FEE - - FIRE/EMS IMPACT FEE DRIVEWAY, REQUIRED; " Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE FFICI` SE O1�L: DI dB PLAN REVIDATE EW FEE: �P RECEIPT NO.: & 6OWa PERMIT NUMBER: VO & • OU7g CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED ' sca' ro St. Lucie County Building and Zoning C�c 2300 Virginia Avenue Ft. Pierce, FL, 34982-5652 ., 772-462-1553 1 APPLICATION for BUILDING PERMIT LSD •D0• CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION SCANNED BY 1. ®LOCATION/SITE ADDRESS: /q7A .7co-P. %tj (%tit, /_F S4 hideCf1[IP!$1/ 2. PROJECT NAME: p,SITE PLAN NAME: 3. ® PROPERTY TAX ID #: 4196 —80,,q —CO-0 -0 CC,6 4. ® LEGAL DESCRIPTION (attach extra sheets if necessary): U T ALk p 0L b CO2 .1176ayy0) 5. PLAT BOOK 6. PAGE NO. \ 7. BLOCK NO. .,8. LOT NO. 9. ®PARCEL SIZE (ACRES/SQ FT.):QOQ v LOT DIMENSIONS: y ', 10. COMPLETE DESCRIPTION OF C/O'NNSTRUCTION PROJECT OR WORK ACTIVITY: LL ��dlf�rn�v1 i/r,..,�1' %i?e�h.�GCir.,., •�.POriuC., , _ 11. *SETBACKS (ACTUAL) FRONT: o'er jj BACK: /.S RIGHT SIDE: 4 LEFT SIDE:�,� 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION WEXPANSION/ADDITION (I INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [I INDUSTRIAL [ ] OTHER (SPECIFY) 13. �® DESCRIPTION OF PROPOSED USE:[QRCtB.va, R�%ei7Ga.�+-•�� ir..t/ 14. ® SQ. FT OF CONSTRUCTION: 3'Aa5 F 15. SF. FT 1st FLOOR: r� 16. VALUE OF CONSTRUCTION: $ �,,•� The value of construction is used to determine the amount of permit fees to he 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 $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCD V Form No.: 001-02 L.. OWNER INFORMATION NAME:/ ADDRESS: CITY: STATE: f9 ZIP: 2 PHONE (DAYTIME): M Sxff� 4�7 _ Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: PHONE(DAYTIME): CONTRACTOR INFORMATION STATE: ST. of FL'REG.CERT #:�/^n OJT y8 ST. LUCIE COUNTY CERT #: ZIP: BUSINESS NAME: 1 r ✓ QUALIFIERS NAME: T mtw_ I 7, 'ADDRESS: ( 34. r _ CITY :/P STATE: 115A ZIP: 33ySs ,,nn PHONE (DAYTIME): _FAXN0.7%aSYG'2/ Emai1.G�5o�iry4ieu-$�42 ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): (� BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: STATE: Im ZIP: 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. 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. 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: 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. OWNER STATE OF FLORID,A COUNTY OF o1/�,[i The foregoing instrument was acknowledged before me this & day of ,ffg�-� 2061 , STATE OF FLORIDQ - `J� P� COUNTY OF / The foregoing instrument was acknowledged before me this day of Ay(/ • , 20—e, by 6?0_ JQW rY_2Z?i %� by k-70y1020 by%77/%l� who is personally known V or has produced who is personally (mown or has produced t;tA • �,• ` . .as identification. p �t l /7 asidentifcation. V'�/dY•cJ p•i/r�P� rgna re otary Sig ature of No Commis tI)RE16.HUMPHRE1y�A11DpPv 9. HUMPNRE'(Seal '' SIBN # DD 63 al Commi °vE: March )D 111 MY COMMISSION# DD 633047 2011 ' +ea yP.W uMemnters !p ? EXPIRES: March 6, VW- ?�, 9ondednhw NOWd Publi<Undernttlers NOTE',=1=wo%z)MGl=RE5IRE RE%TRED. EACH SIGNATURE E 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 checklist. OFFICE USE[QNLY- DATE FILED: 0 PLAN REVIEW FEE: ICZ RECEIPT NO.: CONCURRENCY FEE: RECEIPT NO.: PERMIT NUMBER: CMD - Vag CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St. Lucie County Building and Zoning SCANNED �;1a= 2300 Virginia Avenue BY ORO Ft. Pierce, FL 34982-5652 772-462-1553 St. Lucie County APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: / 2. S/D NAME: bbemu /!YO O SITE PLAN NAME: 3. PROPERTY TAX ID #: 40n4 3 —nr-In _ 1 4. LEGAL DESCRIPTION (attach extra sheets v 1 PLAT 8. LOT 5. BOOK Z� 6. PAGE / ` J � 7. NO. 9. PARCEL SIZE: ACRES/SQ FT. wwLOT DIMENSIONS • 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:j��yy��f� 11. SETBACKS (ACTUAL) FRONT: r BACK: r 7 q RIGHT: SIDE 22- LEFT: r ]� SIDE 3y,9g 5a,3`i as t y 15,36 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [Kj EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) ^/ j �^ 13. DESCRIPTION OF PROPOSED USE: 1jL ell-00 A) / !mil 14. Sq. Ft./CONSTRUCTION: a _S z— 15. Sq. Ft. 1st Floor: 51a 16. VALUE OF CONSTRUCTION: $ 00 The value of construction is used to determine the amount of permit fees to 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 OWNER INFORMATION NAME: N I d' ADDRESS: S t7 J J CITY:.PaC11L,� ln) STATE: FL —ZIP PHONE (DAYTIME): 3 k Lj- ),33 I 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: PHONE (DAYTIME): CONTRACTOR INFORMATION STATE: ZIP ST. of FL REG./CERT Mcr; c 19n)6nCj Z ST. LUCIE COUNTY CERT #: 2L 63 2 BUSINESS QUALIFIEF ADDRESS: CITY: 1P5'%-- STATE: _ FL, ZIP PHONE (DAYTIME): (_� :1Z FAX NO. LIn 3 A _ email: ADDRESS:�� 22�4 Sg P QjrAYI i)YI CITY:.j4U (of '} STATE: )=L ZIP PHONE (DAYTIME): BONDING COMPANY ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: ZIP 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. 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. �OWNER/CONTRACTOR SIGNATURE CONTRACTOR SI STATE OF FLORIDA STATE OF FLORIDA COUNTY OF ! T L.v c. COUNTY OF S+ L_u e. e, The foregoing instrument w acknowledged before me this day of�iL20*Jby , who is personally known to me or who has produced A2,&& &AL A&, _..:i as identification. i nq The foregoing instrument was acknowledged before me this (� i" day of fu /)e , 20 d8, by iraag R l�stek who is personally known e or who has produced as identification. of Notary ie ,Pat•°✓�� Shirley A. Riall Type or Print N e of Notary :Commission # DD462759TY or g ame %WM J MACK Expires September28, 2009 @ MY COMMISSION * DD585699 Commission No (Seal) 'I>x.°4°`' BondW Troy Fain -Insuxnce.Inc. 8003BS7019 COm i Br MtJj"%0 RCdda N°tery SeMm=. NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION. For specific instructions see appropriate permit checklist. OFFICE USE ONLY - - BP #: SECTION � TOWNSHIP (� RANGE l ID L MAP NO. % ] Q� ZONING -, 11 lv LAND USE Q L LOT CVG % r� 69 TAZ NO. FLOOD ZONE ,y L � / / � CJ I FIRM MAP # r lsT FLR ELV MAX HOT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC (before I/90 LOT OF REC (after 1/90 LOT SPLIT REQUIRED LOT SPLIT APPROVED ADMINST VARIANCE LIBRARY IMPACT FEE PARKS IMPACT FEE PERMIT FEE REPORT CODE ^ I �.J I PUBLIC BLD IMPACT FEE HABITABLE AREA RADON RADON FEE R SCHOOL IMPACTFEE GROSS ROAD IMPACTFEE DUE IT FN TOTAL ROAD IMPACTFEE SCHOOL IMPACT FEE C TOTAL SCHOOL IMPACT FEE _ ` POLICE FEE FIRE FEE MISC FEE T4fA��(M POLICE/FIRE MISC FEES ADDITIONAL PERMITS REQUIRED Y N SPECIFY �G PV AJ ij TOTAL of ALL FEES REVIEWS ZONIDATE NG ZONING REVIEWED BY PLANS EXAMRJG MISC. VEGETATION SEA TURTLE MANGROVE COMPLETE Iy� 6/9 !(/' �/�/�� Z� INITIALS J V