HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOF US
E EONLY:
J
DATE FILED:
PLAN REVIEW FEE- RECEIPT NO.: PERMIT NUMBER: 0E2)3' 69AJ3 0
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL -INFO MUST BE COMPLETE at FILLED IN TO BE ACCEPTED
ST. LUCIE,COUNTY PUBLIC WORKS
BUILDING &ZONING DEPARTMENT
2300 VIRGINIA AVENUE " -
FORTPIERCE; FL34982-5652-
561-462-103
.St. udeCourltv
APPLICATION for BUILDING PERMIT
CERTIFICATE ofCAPACITY/ZO.NI.NG.COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:
2. SID NAME: SITE PLAN NAME:
3. PROPERTY TAX ID,#: 3 L4 Z2-'L44-41'0�1 QSO Z
r': I -C 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 3 qq 'A.J/VIO.Y'
A) 10 ON _IZ� bE BSI (/z6`rT P743)
5,- PLAT- 6.-', PAGE 7. BLOCK 8. LOT
660K. NO. - NO. NO.
9. PARCEL SIZE: ACRES/SO FT. LOT DIMENSIONS —75 X 500
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK AcTwrry--,-
rp.�
�AAry-\ I aa,
11. SETBACKS (ACTUAL) FRONT. BACK- RIGHT LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION,.
RESIDENTIAL COMMERCIAL INDUSTRIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSE USE: rtP
1
14. Sq.'PLfCONSTRUCTION-'Sq. FL71loon 077_
1.6. VALUE- OF F CONSTRUCTION: S 0 wo
The valve of ematruction is usad to deternm No axamat of pemtt fees to be assessed. SL Lude county mwAw the right to question w0brinodly the
Ittdi®tad value of oorobtwiiat a C b datsmtrated VWthe sutwnitiod %UM3 am not oitsislantwith skridwiypes of #ihm van b
orroom, 4 RECORDED Notim of Ccmmw=ffwdmmtbe sWnftdwhh this 11voc"am
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME:
ADDRESS:
CITY: t^ L �. I STATE: - aP 3423
PHONE (DAYTIME):
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: 21P
PHONE (DAYTIME): I I
CONTRACTOR INFORMATION
ST. of FL REGJCERT /: L7 I V t) / I 'ST. LUCC.IIE COUNTY C !: /7E7 I �1 . .
BUSINESS NAME
QUALIFIERS NAME
ADDRESS:
CITY: �/'.�fl/l STATE: ./ -1 ) 2IP
PHONE (DAYTIME): � (� . 2-Qd Oo& 3 3 b FAX NO. -I I Z- Z� LO 2 0 %Z
ARCHR/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
- / � I d
IMP
Iffi%fE
234; AM
1 � 1 •
CITY: STATE - ZIP .
MORTGAGE LENDER
ADDRESS: -
CITY: STATE 2IP
'
7NIPORTANT NOTICE: When a permit is issued and It Iwnot picked up within 60:days
after notification it will be voided and returned to you by mall.
e
CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certific ..
capacity„•d applicable, for the, permitted work. I certify that no work or installation has commenced prior to the issuance of a' '
and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understar
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS; POOLS, FURNACES, BOILERS, HEA1
TANKS, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
The following -building permitapplicationsare -exempt -from -undergoing -a-full-concurtency review room additions,-acce-
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to-anothe:
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT- IN YOUR PA --
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OE
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOR
_ - ,YOUR NOTICE OF -COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS 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 ell work will be'done in compti
with all applicable laws regulating construction and zoning.
ERICO NTRACTOR SIGNATURE C NTRACTOR SIGNATURE
STATE OF FLORIDA STATE OF FL�O ^DA^' '
COUNTY OF 1Y) COUNTY OF u_") n
The foregoing ailstrument was acknowledged
fore me this day of&ajA-20 O�by ca
(7n?6t-ieli- who is personally known to me or who
has produced as identification.
Signature of Nb*
4 6
Type or Print Name of Notary
The foregoing Instrument was acknowledged
Wforea is�dayof L20o`,by.
E d who ' rsonall to me
or who produced as identification.,
Signature of Notary
Type of Print Name of Notary
Notary Public Tittle
Cam n Numt Commission Number
,ya wG Hancock
€+car MYCOMMISSIONS DD241920 EXPIRES - h' iaCi:'Hancak -
p ry'" Po K
(sealSeal a••. August 17, 2007 dal +. .rMYOOMMISSION#DD241920EXPIRES
) �fii�@'h;.: soxuonaurROYraxMwauxeu+c' - .. ( ) August17,'2007 .
S` BOWTHRUTROYFAW NSA4NM INC
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN,OWNE"UILDER, THE OWNER MUST PERSONALLY APPI
TO SIGN THIS APPLICATION IN THE OFFICE LIST€D,9N THE FRONT OF THIS APPLICATION.
OFFICE, USE ONLY,----.
.,5,-
SECTION. -:
,C1 • ::
o
. TOWNSHIP..-- !
-.
- �,/„ ^�..;
J6/ ✓
- - -
: RANGE: -
-. - -.
;� j,�� -
- .
,MAP NO
-- -- -
ZONING:
LAND USE;,
LOT CVG
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
mJyPE.
OCCP TYPE:°'°
MAX.000P: `
# OF FLRS:
WATER.
SEWS
SPRINKLERS
STORMWATE
R
LOT.OF, REC
LOT OF REC (aftr 1/90)7 .
LOT SPLIT
LOT SPLIT
DECAL
LIBRARY.
PARKS ,
PERMIT
NUMBER
IMPACTFEE
IMPACT FEE
_FEE
REPORT
PUBLIC BLDG
HABITABALE "
CODE
/-- -
IMPACT FEE
" '
AREA
(RADON) .'
Y
N
ROAD
GROSS ROAD
CREDIT
_
TOTAL ROAD
-
IMPACT ZONE
IMPACT FEE; -
IMPACT FEE
DUE
SCHOOL
CREDIT
TOTAL- -
IMPACTFEE
r
,SCHOOL "
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
.. -.
POLICIiMRE/
-
MISC. FEES
Y
N
ADDITIONAL
SPECIFY: i
TOTAL ALL
PERMITS
FEES
REO'D
REVIEWS
-ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
-
TURTLE
DATE
COMPLETE
-