HomeMy WebLinkAboutBUILDING PERMIT APPLICATION3P #:
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OCCP TYPE: '
MAX. OCCP:
# OF FLRS:
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LOT OF REC (aftr 1190)
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DATE FILLU: NUNIBER:
PLAN REVIEW FEE: c0O RECEIPT NO.: PERb1IT ��
_ ONCURRENCY FEE RECEIPT NO • � � CERT• CAP. NO.:
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ALL INFO MUST BE COMPLETE 8t FILLED IN TO BE ACCEPTED
ST. LUCIE COUNTY PUBLIC WORKS
y� BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT -PIERCE'• l-34982-5652 SCANNED
ZORIOP Mi-462-1553 BY
St. Lucie Coup
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
�r / G�_ ✓ �/IG�
1. LOCATION/SITE ADDRESS: /• �l� �v` �� �r J Q
dze
2 S/D NAME: i4►7 D/ /✓� SITE PLAN NAME: �7'1 / , i
3. PROPERTY TAX ID #: 333 `f - 50) - o / 98
4 LEGAL DESCRIPTION (attach a tra sheets it ne Ssary).
LIBRARY
IMPACT FEE
PARKS
IMPACT FEE
PERMIT
FEE
On n�� •lA'fGpr,���5�- }-�11Cu2.��(.(n
PUBLIC BLDG
fiABRABALE
RADON FEE
5. PLAT 6. .PAGE BLOCK �D 8. LOT �}
�.-� NO.'
IMPACT FEE '
AREA
BOOK NO. No.
(RADON)
ROAD
CREDIT
NGROSS
H
TOTALROAD
9• PARCEL SIZE: ACRES/SQ FT. r 20;,4Clt LOT DIMENSIONS
IMPACT FEE
IMPACTFEE
DUE
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
YEl
A'<� s A
TOTAL
I
SWIMMING POOL & DECK
CREDIT
<; :::. ^
Mf SS i'S a�::
;.,.:; ' `.:. '.:
x>..:;x_ Mx>::..
SCHOOL
IMPACT FEE
'
11. SETBACKS (ACTUAL) FRONT: ` BACK: / RIGHT // r LEFT II
�✓
SIDE Ca.O SIDE: �1--
Fry RE FEE'
,
MISC FEES:
TOTAL
I•
i'
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
POLICEJFIRE1
MISC. FEES
`
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION•.
TOTAL ALL
1
E<# RESIDENTIAL .• [ ] COMMERCIAL [ ] INDUSTRIAL
SPECIFY:
••
FEES
{ ] OTHER(SPECIFY)
13. DESCRIPTION OF PROPOSED USE: RESIDENTIAL
VEGETATION
SEA. MANGROVE
14. • Sq. FMONSTRUCTION: l v�v 15; Sq. F.t 19t Floor.
ZONING
REVIEWED BY
PLANS
EXAMINING
TURTLE
16. VALUE OF CONSTRUCTION: a 18 r 0 0 0.0 0
/f
Q�
the &Mount of pemu)t fees to be assessed. St. Lucle Canty resar m the eight to Wbs6on for modltl
The value of construction l a:
�;
Is used to detenolne H the value
Y�cated value of carrotirxtion N q b dertrorgtnted that the Nrbrrrltled ffptaes are nol oonahtenl with sMylar 4'Pea d oornuuctloM adt�aa•
or more. a RECORDED Notice of Connanoement must be eubmltted with fhb appticitfon.
I.
V Form No.: 001-02
CERTIFICATION:
R INFORMATION: -
RESERVE HOMES, LTD. LA
5s:
P2E, T. LUCIE FL zip-342:��
(DAYTIME): f 77$ 468-4703 33�LD�
SEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
APLE TITLEHOLDER:
:SS:
STATE: ZIP
E (DAYTIME): f I
TRACTOR INFORMATION
FLREGJCERT8: CPC 0057200 ST.LUCIECOUNTY CERT#: l�IO
IESS NAME: A & G CONCRETE POOLS, INC'
IFIERSNAME:-- ARTHUR H. ALLEN
ESS: — 410 SAEGER AVENUE
FORT PIERCE STATE: FL ZIP 34982•
E(DAYTIME): f 77a' 878-7752 FAxNo. 772=467-1624
Ir/ENGINEER: RAY REINHARD
LESS:
VERO BEACH
IE (DAYTIME):
ANG COMPANY:
LESS:
TGAGE LENDER:
RESS:
STATE:
STATE:
FL
yp 32960
21P
STATE: 2JP
PORTANT NOTICE: When a permit Is Issued and it Is not picked up within 60 days
or notification It will be voided and returned to you by snail.
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain -a certifical
capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a pe
and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HE -ATE
TANKS, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
The following building permit applications are exdmpt from undergoing a full concurency review: room additions, acces
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAl
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OB-
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORE
YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FORTHIS BUILDING PERMIT,.IF IT IS NOT YOUR RIGHT: TITLE.
INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS PERMIT
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION
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 comp)
with all applicable laws regulating construction and zoning.
OWNER/C(5RACT ell GNATURE
CONTRACTOR SIGNATURE
STATE OF FLORIDA
STATE OF FLORIDA - ,
COUNTY OF
COUNTY 0175�- L uc,-a.
fihe foregoing instrument was acknowledged .
The foregoing instrument was acknowledged
before me this day ofd�_, 20_, by _
befoqr�e me this�t��f �20�1, by
who is perso all known to me or who
(I14,U A.o\W\. o is ve ona Y o
has p/r,Iofduced as I entfiCation.
or wpe-has-pred"^^ + ec iriwntt w ion.
---_�
Sign
re o ota`)��,`` M.BUON//�e,,
Signature of Notary
1 _
,l �b�er2
Type or Print NarterQfCY� " ; * =
Type of Print Name of Notary
' �Z,; #DD 355325 c
Notary Public J'ke°(= eonaeamN :'oQa
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Notary Public Title
Commission W�r>a1e
T)UJI&L-?,ommission Number
PATRICIA M. GIUNTA
ka •Commission N D00103400
nap
Exphes 3126 0W
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BOO dwon I
WO-032425/ FbtIAB Notary Awn., Ine J
SIGNATURE MUST B -'NO Tf fZED"" ......"........
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEFVBUILIDE R. THE OWNER MUST PERSONALLY
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.