HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICEUSELE_ONLY: 3
DATE FID: i
PLAN REVIEW FEE: RECEIPT NOP / �J
CONCURRENCY FEE, RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
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� r ".JI r _ •� PLANNING &DEVELOPMENT SERVICES DEPARTMENT
_ O BUILDING & CODE REGULATIONS DIVISION
f� 2300 Virginia Avenue
V Ft. Pierce, FL34982-5652
772-462-1553
I► ,,K,ca, —� C� a 'BM a vcl9rm 1-4-
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
TOECT INFORMATION
1. LOCATION/SITE ADDRESS:
2. PROJECT NAME: SITE PLAN NAME: _
3. PROPERTYTAXID#: ✓��' 6�1 �'Zl7/_ '
by
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 29�7 6. PAGE NO. 01 S G 7. BLOCK NO. � �'� 8. LOT NO. G
l
9. PARCEL SIZE (ACRES/SQ FT.): ct0.2 3 LOT DIMENSIONS::� Y i� k - 20
Rfp1ocPty)ePr h6me-
10. CO LETEDESCC/RIPTI NOFCONST/RUCTI P/ROJE/G7O/ WJ�RK CTIVI
/O r—pirz O /i X., inn /yl--�
II. SETBACKS (ACTUAL) FRONTZA BACK: _y RIGHT SIDE: LEFT SIDE: '
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[� RESIDENTIAL, [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
Ma If, tQ.+
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
4le. lv !/; %o-1
SQ. FT OF CONSTRUCTION: I • 15. SF. FT Iat FLOOR: !' `' 15 45
VALUE OF CONSTRUCTION: $ 8 5* 6 bo' �J
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 ifit is demonstrated that the submitted figures arc not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice orCommenecmenl must be submitted with this application.
SLCCDV Form No.: 001-02
t I
' UPDATED 6/25109
i
OWNER INFORMATION
NAME: 7 2� i/ �� 2 r-cl 5 S
ennurcc• `I6 ,6 jft>eqIri 2 J e.
CITY: l i e G`c STATE: G• ZIP: 3 y 9-5 1
PHONE (DAYTIME): cMM 16 d 2� i 2 IS 2-75 Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
/ q
ST. of FL REG.CERT
BUSINESS NAME:
_ ST. LUCIE COUNTY CERT #: V 1
.5ri(2/JLT/or L`oie .
QUALIFIERS NAME:
ADDRES$� �zy /S� S2n %2 av2
CITY: T/J��y`G `s�"q 2 �7 STATE:
PHONE (DAYTIME): C::E 9 2 / 6 �° / FAX NO.
ZT
ARCHIT/ENGINEER O J K //C-f-e �M.l rr'Le
CITY: ShI �Qf✓Y'Y�'iY�{ s� r-�>
PHONE (DAYTIME): -"6 _ -65� 31
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE:
STATE:
ZIP:
Email:
G-6,S`�. s IIC:S -!Y�- u-
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 i i I i
I
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 the permit 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 TIES 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.
STATE OF FLORIDA
�} / A p
COUNTY OF II (Ay
The foregoing instrument was acknowledged before
�
me this day of �20 ,
byrtlIIY Iyi Vt Mdr'—i -'
who is personally known `� or has produced
of
Commission
V V
CO CTOR SIGNATURE
ST TE OF FLORIDA
COUNTY OF ��• WGI
The foregoing instrument was acknowledged before
me this Wnay of "y(All ' 20
by JAI i D FDV&D
who is personally known v or has produced
BRITTANY SMrrH-''CO mission No.
MY COMMISSIONtEE 026613 e
EXPIRES: September 16, 2014
Bonded Thm Notary PuMt Underc+rtters
NOTE: TWO (2) SIGNATURES ARE 'REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
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 OWNERBUILDER APPLICANTS,
For specific instructions see appropriate permit checklist. i
( i
EE02661
er 16.2(
OFFICE USE ONLY BP #: / U c;? 0
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
Rsy
LAND USE
J `
LOT CVG %
I �•
TAZ NO.
FLOOD ZONE
FIRM MAP #
C)
1 T FLR ELV
1_
MAX HGT
CONST TYPE
-
OCCUP TYPE -
MAX OCCUP
# OF FLRS
WATER
SEWER
' b6 I (SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before]/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
/.� J
AREA
FEE
FEE
f
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
IMPACT
IMPACT FEE
IMPA
IMPACT
FEE
CORRECTION
FEE
GENERAL
SCHOOL
ROAD
_
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIREIEMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO,ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
.PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNWR
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
Ill,(3
RECEIVED
DATE
COMPLETED
I
INITIALS
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