HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOl'F3'I�E C1S}'? b�LY'DATE FILED: 4 : _ a y�
PLAN REVIEW FEE: RECEIPTNO.: 9 67q PERMITNUMBER / 70�, °p�lJ
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
NTYBUILDING & CODE REGULATIONS D"I�T'"' -
a 2300 - l�72-46 Virginia553 ue�—CD,
Ft. Pierce, FL 34982-5652
-- 772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
SCARP
PROJECT INFORMATION BY
1. LOCATION/SITE ADDRESS: 3401-F Ay,0, V� a.n •`� aYllIN6L41"L
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID ik -2, /-/O 5- loO / 0 O 9 S A
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. S. LOT NO.
9. PARCEL S12F (ACRES/SQ FT.): LOT DIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
/7q)f X C (� 1 i
11. SETBACKS (ACTUAL) FRONT: BACK
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION
RESIDENTIAL
OTHER (SPECIFY)
RIGHT SIDE:
LEFT SIDE:
[ ] EXPANSION/ADDITION [.] INTERIORRENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
13. • DESCRIPTION OF PROPOSED USE:
Tr
14. SQ. FT OF CONSTRUCTION: '5 0 15. SF. FT 1 at FLOOR
Apt
16. VALUE OF CONSTRUCTION: S < 0 Q' o
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 am not consisterd with similar types of construction activities. if the valucis $2500 or more, a
RECORDEDNofice of Commencement most be submitted with this application.
SLCCDV Form No.: 001-02
' UPDATED 6/25109
OWNER INFORMATION
NAME:. n 0, LJi /I �� c CJIc�!q
ADDRESS: Ef o I I=g a
CITY: � _ �f Q ! e STATE: r ZIP: 3 q �F
PHONE (DAYTIME): (`7 23 a Q ! eg C, '7 ESE:
�
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME): L—)
CONTRACTOR INFORMATION
-ST. of FL REG.CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
STATE: )( I ZIP:
STATE:
PHONE (DAYTIME): (_, FAX NO.
ARCHIT/ENGINEER
ADDRESS:
CITY:
PHONE (DAYTIME): C--)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER: _
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ST. LUCIE COUNTY CERT #:
Email:
M7
mg
M
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, 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.
'OWNER OR CONTRACTOR SIGNATURE
STATE OF FLQIZID .
COUNTY OF 9 : A c .
The foregoing instrument was acknowledged before
me this 3 day ofTW"— 20 ,
by )at ��li`�R n
who Is personally known ` or has produced
.Ig)1 • S4323" 0 as identification.
of Notary
Commission
CONTRACTORSIGNATURE
STATE OF M
COUNTY OF VL0�t
The foregoing insh at ant was acknowledged before
me this 3 .�5� day of 20
th1�
by fUw
who is personally known y or has produced
J��'$Ol•�D3 b as identification.
Signature of Notary
Commission No.Agia
NA INGR
MW Eoso95a
cember20,2014
ypu Nadc+xtiters
NOTE: TWO (2) SIGNA QUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR ITO 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 inPtructions see apRropriate permit c`lheddist.
+ 'r
OFFICE USE ONLY BP #o
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
4i 1,
4J �I
LAND USE
LOT CVG %
I i�C.P
TAZ NO.
FLOOD ZONE
FIRM MAP #
IT FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 111990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
06
HABITABLE
AREA
O
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BLD
IMPACT
FEE
GENERAL
PARKS
WACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FRt&EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC_ ROOF
ELECTRIC GAS
PLUMBING _
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
1
DATE
COMPLETED
S1
DEFIALS
30. 6 7X /% 33 = S32 sF
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