HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY BP #: O 70 V- psiDATE FILED -
SECTION
Ja
TOWNSHIPS
RANGE
4/
MAP NO.
3SoZQ s
ZONING
�
LAND USE
P IF
LOT CVG %
TAZ NO.
FLOOD ZONE
aK�
FIRM MAP #
3Q31 4,
IsT FLR ELV
9.
MAX HGT
CONST TYPE
�
OCCUP TYPE
(((/// /
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC (after
LOT SPLIT
LOT SPLIT
afore 1/90
1/90
REQUIRED
APPROVED
ADMINST
LIBRARY
PARKS
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FE
REPORT
3a S
PUBLIC BLD
HABITABLE
RADON FEE
CODE
IMPACT FEE
AREA
O
Of�D
L
GROSS ROAD
CRE
Y
N
TOTAL ROAD
IIKPGi1TE
C
IMPACT FEE
IMPACT FEE
•7
DUE
SCHOOL
CREDIT
N
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL
Y
N
SPECIFY
TOTAL
PERMITS
of ALL
REQUIRED
FEES
REVIEWS
ZONING
ZONING
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE -
REVIEWED BY
EXAMIDATE NG
S S 0-7
p
` /7 -o
J�
COMPLETE
1 r�
-
INITIALS
OFFICEUSEDNLY: ` ''11�J{� J�jfj
PLAN REVIEW FEE: 0-,�y REOCE T NO.: �r PERMIT NUMBER: V / ✓ I
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED
PROJECT INFORMATION
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL COMMERCIAL [ ] INDUSTRIAL
{� OTHER (SPECIFY) 771G.l,�A
13. DESCRIPTION OF PROPOSED USE: f1N MA7UNt'fa EptL'WLJYI//C1 /' C.7fi!^ 1/NI CIh, tM/S �!O6„j&�k
14. Sq. Ft./CONSTRUCTION: �- t 15. Sq. Ft. 1st Floor: (<J
16. VALUE OF CONSTRUCTION: 0 c%
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 Commeucemen[ must be submitted with this application.
SLCCDV Form No.: 001-02
31-Lu,C;6CO, FT Plf.-04E FIR,g %id'r
A466 P.006e TSU40 ,AV6
Fa r AIiR c� F�. s� •;,�
OWNER INFORMATION J� '
NAME: ST L VL t r ('0 v &JA I'1 0) Ls J R-t c e—
ADDRESS: S/(o d/ J I J b0rtL tt_&'Y /�)2.
CITY: I'p/-r- S z L. U i E STATE: (rf- ZIP 3 L(erg 3
PHONE (DAYTIME): ')) 6 Z( 3Yfv I email: Ci t k t P S L L Fb . o LA
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 #: GCL ST. LUCIE COUNTY CERT #: L [O 2
BUSINESS NAME:
QUALIFIERS NAME: GJ e L L_t A-t-N L. 9" w n t T(T
ADDRESS: $ (S S . I4 NrS Avis.
CITY: f j QAAyJ D o-tJ STATE: FT_ ZIP 3 3 5-((
PHONE (DAYTIME): (3 `j L t�?(rFAX NO. 5 / 6Y?,email: b ll a br `aX A • OeL-j
ARCHIT/ENGINEER:
ADDRESS: l_b1)7 wr�T & y_&0 t rns Si -
CITY: A Mir i s (= r STATE: FL ZIP 3 3 S 6 3
PHONE (DAYTIME): (`tl� 00-03 62—
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.
r
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 a ble laws regulating construction and zoning.
OWNE &R SIGNATURE
a—
-9ONTRr19TMSIGNATURE
n9G
STATE OF FLORIDA — 99�
STATE OF FL
COUNTY OF n N m
�a a yZG
COUNTY OF
The foregoing instrument ac owled ed 9 es
}m � p. o y
before me thi day of 20by
The foregoing instrument wa ackpowledged
before me this �Fday of/ttQ20 b
�/%(L/✓+Q/71pltJN ho is personally m
�(itLL� 9 mj rJq/ jf[who is personally
•
known to me o/r-�w has produced
known to me or who hag -produced
as identification. Q
O
Aso• 4�� �� Y
�4 ¢'�Q. 12 (tj as identification.
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Signature
� Si ature
.�ooAf/N�ota�i�t' ��/��/�Q��/yympp''�''��l�
X.
/y p
Type or Print N e of Notary /NNE
T
' Type or Prin am of Notary /
Commission No. (Seal)
k mmission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNR�ICMUST 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.