HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONvd3'IIYIt�t� � a � 1
QFFICE IISE ONL ' _
>� �Ude �'OLI111tV
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO. PERMIT NUMBER: L 1
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATION DIVISION
2300 Virginia Avenue Ilppvv��jjVV�))
Ft. Pierce, FL 1553 5652 ^ e U ^
772-062-1553 A n �� I J\ Ull.
�C(�
vc
APPLICATION for BUILDING PERMIT cp��A
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1. LOCATION/SITE ADDRESS:
2. PROJECT NAME:
3. PROPERTY TAX ID #: y�
PROJECT INFORMATION
SITE PLAN NAME:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLATBOOIC\-:,�S 6. PAGENOAVE- J 7.
NO. Z 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): d`� LOT DIMENSIONS: --3 l I, X of
10. (COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACT
11. SETBACKS (ACTUAL) FRONT: \0 V BACK: C—:� RIGHT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION
RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROD
LEFT SIDE:
Q.
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
SQ. FT OF CONSTRUCTION: y9S Y Ir 15. SF. FT 1st FLOOR:
VALUE OF CONSTRUCTION: $ ROO 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 are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement most be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25109
OWNER INFORMATION
NAME: n
ADDRESS:_
CITY: STATE: ZIP:
PHONE (DAYTIME): & - 39 - $% �d 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:
CNYa'A
PHONE (DAYTIME): U
CONTRACTOR INFORMATION
STATE:
ZIP:
ST. of FL REG.CERT # SST. LUCIE COUNTY CERT #:
BUSINESS NAME: �Y-X 0-- \Ce--
QUALIFIERSNAME:
ADDRESS:\t-At-\ '�i\o
CITY: QkP STATE: QQZIP:
PHONE(DAYTIME):���11-S1Dl� FAXNO�a-c�'�y3clEmail:�S\Ue����5�� C.
Cs:,nc�aS� . met
ADDRESS�:i b UO N4-Ne -(a c-c\ `-T _
CITY: STATE: ZIP: yJy�Ei�`J
PHONE (DAYTIME):
BONDING COMPANY
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
ZIP:
STATE: ZIP:
EAPORTANT 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 thepermit 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.
/&., 4JZ`�� 1
a ;.
STATE OF FLORWA
COUNTY OF w`-,Q
The foregoing instrument was acknowledged before
methis'�A day of CDC_•t- 20 kl ,
by `! \Asp CMbWV-N
who is personally known ✓ has produced
identification.
Signature 0 0 ,Y,,,STELLA M I
: Notary Public -
Commission o V•• .' m L.Pi
Commission N
Banded Through Nam
STATE OF FLORIDA
COUNTY OF t�t- P e . e_
The foregoing instrument was acknowledged before
me this _on_day of bC.-'\, 20 4.3 ,
by we'
who is personally known . — or has produced
as identification.
STELLA ,�F a ` ELLA M HUNTER
Notary Public - - 'tTb �ota, Public - State
My Comm EePi SE • 1of Florida
5 1y Comm. E..pirn 23, 2L
es Ja
Commissio •o$ b._
Bonded Through N - I%J(dgi Vdssn. nded Through National Notary Assn.
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 checklist.
OFFICE USE ONLY:
DATE FILED:
REVISION FEE:
f AF i Yl jW
Sy tude(hito/
PERMIT#
RECEIPT #
SCANNED
PLANNING & DEVELOPMENT SERVICES BY
BUILDING & CODE REGULATION DIVISION St. Lucie County
2300 VDtGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
. _.
APPLICATION FOR BUILDING PERMT
-
PROJECTINFORMATION
J
1. LOCATION/SITE
ADDRESS:St
pFH%//
2. DETAILED DESCRIPTION OF�I20NYG .
REVISIONS: FL
pp \\nn
See
See �,RCO�SJS2S� ``?15��5
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: ST. LUCIE COUNTY CERT. #:
3 i�)a �b I
BUSINESS NAME: -C -$ s Cal oho,\ 2 \A-O Z� e- Sp—c m Nye..
QUALIFIERS NAME: c,a•�t . S S�v a c-t'
ADDRESS: \IsyL1
CITY: STATE: L.
ZIP:
PHONE (DAYTIME): FAX:
4. OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE:
5. ARCHITECT/ENGINEER INFORMATION:
NAME: _
ADDRESS: _
CITY:
PHONE (DF
SLCCC: 923/OS
Revised 04262
STATE:
40bl6
�®&
10 4 4"�y4jNo 41491,?
co4n�F<
r
OFFICE USE ONLY BP #:
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
��
LAND USE
i l ,
l
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
ISr FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OFFLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
'After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
^
( A��
v1
HABITABLE
AREA
O
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUB
ACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPA
FEe
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC_ ROOF _
ELECTRIC GAS
PLUMBING V
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
✓
DATE
COMPLETED
Q'
.
INITIALS