HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFTCE'USEONLY:• }
DATE FILED �� a ���
PLAN REVIEW FEE: T=DQ RECEIPT NO.: PERMIT NUMBER
CONCURRENCY,FEE: RECEIPT -NO.: CERT.CAP. NO.:
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING,& CODE REGULATIONS DIVISION
.. ;2300 Virginia Avenue � 7 � _ a� ba�„
SCANNED Ft. Pierce, FL 34982-5652. (.liGl�L gyp-{
BY 772-462-1553 �� e
St. LucieCounty jVe4
APPLICATION for BUILDING PERMIT ([ h I
CERTIFICATE of CAPACITY/ZONING COMPLIANCE v `f�
PROJECT'INFORMATION
1. LOCATION/Srm ADDRESS: //0 3 J /Lra.J ?A, P zr S,- LaGS: A. 3149 s2.
2. PROJECT NAME: (j2V41 AN ti S£a.t EtL, SITE PLAN NAME: U.)t uA dM ESS ti.H E-P,
3. PROPERTY TAX IDt 3414-501-070_ 000-3
4. LEGAL DESCRIPTION (attach extra sheets if necessary): l or 14 61--cg- 3 5-r L40(1,Gniw ,N
SEC, 2 3
5. PLAT BOOK 6. PAGE NO. 7. BLOCK"N0. 3 8..LOT NO. 4
9. PARCEL SIZE (ACRES/SQ Yr.): Ib /pnE S LOT M ENSIONS: _434,k t 32 o
10. COMPLETE DESCRIPTTON.OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
LI)OAJSrguCr 3Gx.lak5 7//eF s«e, �urcarN- w G!,4 4'
#" (wAgrE 1co4Ttv1r SMR no P 1 /rJ�LylaF KEsrf WOO 3� I
11. SETBACKS (ACTUAL) FRONT: o2419 . BACK: 190", lib ' RIGHT SIDE: , 3 v ` LEFT SIDE: o!4{o, o } `
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ j RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) //
13. DESCRIPTION OF PROPOSED USE: i ozw- kaa 5-"-6;,9e£
;5w6-• b-ca,
14. SQ. FT OF CONSTRUCTION: .2706 IqTD 15. SF. FT 1st FLOOR:
16. VALUE OFCONSTRUCTION: $ 911 Ia3 $ 0 o
Ilevalue of construction is usedto detemnine the amount ofpemdt fees to be assessed. St:Lucie County resetves,tte rightto question and/or modify the indicated,
value ofconstrucdon iritis demonstrated that ttesubmiltcd figures arc not consistent with similar types ofconstniclion activities. 9r the yalucis S2500 ".more; a'
RECORDED Notice ofComnirnccmenrmustbe submiued'wilh this-appliratom
SLCCDV Form No.:,001-02
UPDATED 6/25109
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OWNER INFORMATION
NAME: -
ADDRESS: Ilb:. -n L-rbwl VOL'
CITY: Pnftx Sr' WC«. STATE: ZIP: 9 Sa
PHONE (DAYTIME): "( j-V ;L 01 - 3l( S L 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:
F:r70]:7431;
CITY:
PHONE (DAYTIME): C_
CONTRACTORJ�NFORMATIO N
ST. of FL REG.CERT #: D 3G 341 ST. LUCIE COUNTY CERT #: o') 0 $ 7 9
BUSINESS NAME: k 0 2Twi (3t l Ul Ir*6S-
QUALIFIERSNAME: e-RoJAL-n 5Lkrrb.)
ADDRESS: a S a W • A-vAFHS
CITY: b6ga WJ STATE: 1L. ZIP: (0 1 SS'D
PHONE (DAYTIME): 3( vg) �9(,3 - W 7 V FAX NO. Email:
STATE:
ZIP:
ARCHIT/ENGINEER
ADDRESS: 016'a CJ /YDAN$
CITY:
i
PHONE (DAYTIME): (314) a43 -7 it 7 `/
BONDING COMPANY
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP: 1, l y -a
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.
i
M
J_'
C . E-RTIF'JCATION:
St. 1,ucic County mpkes,jjo,Kcprc5cntjdon tbat its gmth'94 a Ptrmit -W-. v '-
IaA" or auy dovenants.j6t May iestri,# at inkehibit such
which is in, conflict with any.appj�6b,!Q florucQWndr ASSOOWMIOIM:6�1 I . " , . -
ation ' ' dedd for !my rdstddiolls Whic"'"ay. apply.
structure. AC�secohsWtwi�your.Romeo.�Ivner?sA,4s,�, andrmewyour
The fbil6wing building permit applications 2re, exempt fliom undcrgojng a ,ffill conc=,cEjcy:rcvicW. room ',additi0w,'A9';cssqry
structures (all types), dwinamIngP
uses t , o another non-
,
ouls, fbdces, walls, signs, sdeen roon's, utl Ity xi&tiumnsaccessory
i6idditial use.
NOTICE TO OWNER-,
NOTICE TO APPLICANT:
_W�NERWR CONTRACTOR SIGNATURE
STATEOFF,LORIDA
COUNTY OF
The;focegoinginstrumentWas 2&nowjjdged before
mq'ihIs_-day,of
by
who is parsolially-kn6wfi _ or.has produced
as identification.
Signature of Notary
connuisgton No.. (Seat)
NOTE.
CONTRACTOR SIGNATURE
STATE Op+ti OMAr"4 '0
COtNtV OF L9.7—, eu2 U
The foreg
oing ppiore
2OJ3�
by I RLvA swt 4"
asid0itificadoM
Pam(
Signature of Notaia.
OFFICIAL SEAL
4CorafinisidouNo, __B9BI10K H. (MONEY
MY
PUBLIC,
IC, SWE OF ILLINOIS
Y COMMISSION EXPIRES 11 -29-2015
for'.9pecit ripme
twiris see <2koftdpriate pdrtfiit 41IWdisto
t
ONLY '_ -` ;, #: Iml.c'x3t�`i
FUSE
TOWNSHIP
RANG
MAPNO.
LANDUSE
LOT CVG %
TAZ NO.
FIRM MAP #
I'TFLR ELV
MAXHGT
CONST TYPE
f 1
`J
OCCUP TYPE
%�
�/
MAX OCCUP
# OF FLRS
/
WATER
SEWER
SPRINKIERS
STORMWATER
LOT OF REC
Bduiet/t990
LOT OF REC
ARer1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACTFEE
CORRECTION
PUBIC BID
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIRFJEMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINLSLRATIVE
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
DAE RECEIVED
1
DATE
COMPLETED
��
INITIALS
:5�i/SQ 5 F
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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 palmmed 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, FTC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the pertnit holder to build the subject stnmtuac
which is in conflict with any applicable Ilomeowner 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, forces, walls, signs, screen rooms, utility substations & accessory uses to another non-
residmdal 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 THAYIS SUBJECT TO
ATTACHMENT% AS A CONDITION OF ISSUANCE OFT] IIS 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 ORCO,VTRAC :SIGNATURE CONTRACTOR SIGNATURE
STATE.OF FI;eRIMA / do i r STATE OF-FLA)RiDA
COUNTYOFgp_/I COUNTY OF T1c7-e1'2i1
The foregoing Instrument was acknowledged before
me this I V' day of r ntJar 20 13
by jfDA cu d L. &-, ,'jot'
who Is personally known >( or has produced
/ as identification.
Signature otary ^ -\' C LL SEAL
JUDITH R VEST
Commission NoNOT(P&F)JBLIC-STATE OFILLINOIS
MY COMMISSION EXPIRES:04/20114
The foregoing instrument was acknowledged before
me this .Z3 day of T n ..i:. A tr-1 , 20-L3
7
by S,44"-,
who Is personally known
W
as identification.
NOTE: T�, O'{2I Ig " S AR>ryREQUI1tED EACR SIGNATURE MUST BE NOTARIZED, IF APPLYING FOR
THIS BUILDING PERMIT AS R/BUILDER, TTiE 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 OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist. ;
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