HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONO3P•�FIGE C7SR t lrjz
DATE FILED: Q
BP #: aSO �/ ,
PLAN REVIEW FEE: 95 — RECEIPT NO.: a PERMTT NUMBER:
0501
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
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ALL INFO MUST BE COMPLETE u FILLED IN TO BE
ACCEPTED
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ST. LUCIE COUNTY PUBLIC WORKS
SECTION:
TOWNSHIP:
RANGE:
7/ /
MAP NO.:
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® BUILDING & ZONING DEPARTMENT
—
2300 VIRGINIA AVENUE
SCANNED
�ORtDP FORT PIERCE, FL 34982-5652
ZONING:
LAND USE:
L�' r
Mom/
LOT CVG %:
NO.:
772462-1553
BY
St.Li1CIP.IolJO
FLOOD ZONE:
FIRM MAP #:
1ST FLR
MAX HGT:
7� /� '�7 7T T77�7 r
APPLICATION for BUILDING ILDI G PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
CST TYPE:
OCCPTYPE:
MAX.00CP:
#OFFLRS:
PROJECT INFORMATION
WATER: I I SEWER-: I I SPRINKLERS
LOT OF REC (befr 1/90) I LOT OF.REC (aftr WO)I I LOTT SPLIT
STORMWATE
R
LOT
1.
2.
3.
4.
LOCATION/SI
S/D NAME:
PROPERTY TAX ID #: Z/ D 2 — S D — 0,5 7,,9 — a Q 0 3
LEGAL DESCRIPTION (attach extra sheets if necessary):
Al
' DECAL
NUMBER
LIBRARY
IMPACT FEE
PARKS
IMPACT FEE
PERMIT
FEE
/ SP
j REPORT
CODE
/�
y /cam
PUBLIC BLDG
IMPACT FEE
HABITABA
AREAQN
\
RADON FEE
,
S 6. NAOGE 7. BLOCK LOT
,�8. OOT
/ J
BOOK 7 D O
Y N
ROAD
IMPACT ZONE
GROSS ROAD
IMPACT FEE
CREDIT
TOTAL ROAD
IMPACT FEE
o� �
9. PARCEL SIZE: ACRES/SQ FT. JCS( ToZ LOT DIMENSIONS S X $
DUE
10_ DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
SCHOOL-
IMPACT FEE
CREDIT'
N
-
ws
` z -
TOTAL
SCHOOL
'
C
IMPACT FEE
/
11. SETBACKS (ACTUAL) FRONT: ACK: i/RIGHT LEFT 8 !
!y -5_ SIDE d SIDE:
POLICE FEE
FIRE EE
MISC FEES:
TOTAL
POLICE/FIRE/
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
MISC. FEES
9
Y
N
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
ADDITIONAL
SPECIFY:
TOTAL ALL
[ ] RESIDENTIAL [ ] COMMERCIAL � �'�— [ ] INDUSTRIAL
RMI
PERMITS
FEES
.,
D4 OTHER (SPECIFY) o
REaD
.2.
13. DESCRIPTION OF PROPOSED USE:
REVIEWS
ZONING
ZONING
PLANS
' VEGETATION
SEA
MANGROVE
14. Sq. Ft./CONSTRUCTION: %3 8 15. S Ft. l st Floor:
q•
.REVIEWEDBY
FJWMINING
TURTLE
_ -
16. VALUE OF CONSTRUCTION: $ o '
DATE
COMPLETE
3 t7�
D 3
i0.ly.o,i�
)Uli
The value of construction is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the right to question and/or modify the
-
INITIALS
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indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. It the value is $2500
or more, a RECORDED Notice of Commencement must be submitted with this applig6on.
SLCCDV Form No.: 001-02
OWNER INFORMATIOI
NAME:
ADDRESS:
CITY: hiJ�-'J �h+ �/J-�'� STATE: / ZIP
PHONE (DAYTIME): 1' 7
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: A) aZ2
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): f 1
CONTRACTOR INFORMATION y(P
ST. of FL REGJCERT A: ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:.
ADDRESS:
CITY: V - - STATE- ZIP .
PHONE (DAYTIME): f 1 FAX NO.
ARCHIT/ENGINEER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): o f 1
BONDING COMPANY:
ne�P
o
ADDRESS:
CITY- — - STATE: ZIP
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
ZIP
IMPORTANT NOTICE: When a permit is issued and it is not picked up within fi0 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; 1 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: 1 certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
NE Ci IGNATURE
CONTRACTOR SIGNATURE
STATE OF FI_ff0DA
STATE OF FLORIDA
COUNTY OF CGS
COUNTY OF
The foregoing irstrument as acknowledged
The foregoing instrument s acknowledged
before me this l day 20Q�by/
?fs�Ncf2rwho is erso II known to me or who
before me this _day of 20_, by
who 1 ersonally known to me
has produced_ as identification.
or who has produced as identification.
�3 � • ado-4�fo-Ib�•
D
Signat a of Notary
Signature of ary
Type r P nt Name of Notary
Type of riot Name of Notary
�;,t
Notary Public Title
ota Public Title
za�a
Commission Number o m
Commission Number
�L
z�oi
'
(seal) g a
(seal)
6 ox
j$ 0
NOTE: TWO (2) SIGNATURES ARE REQUIRED EA
NATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PE 0
WNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.