HomeMy WebLinkAboutBUILDING PERMIT APPLICATION. � R
BP #:
.. _ :OFFICE -USE ONLY
SECTION:
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TOWNSHIP:
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RANGE:
MAP NO.:
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ZONING: _
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LAND USE:
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LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FUR ELV:
MAX HGT:
CST TYPE:
OCCP E:
MAX. OCCP:
# OF FLRS:
WATER
SEWER:
SPRINKLERS
STORMWATE
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LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REO'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACTFEE
FEE
REPORT
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PUBLIC BLDG
HABITABALE
N FEE
CODE
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IMPACT FEE
AREA
(RADON)
Y
N
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACTZONE
IMPACT FEE
IMPACT.FEE
DUE
Y
N
SCHOOL
CREDIT
TOTAL
-
IMPACTFEE
da
SCHOOL
-
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
�`
TOTAL
POLICE/FIRE/
MISC. FEES
Y
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ADDITIONAL
CIFY:
TOTAL ALL
PERMITS
FEES
REC1'D
REVIEWS
ZONING
ZONING
PLANS
(VEGETATION
SEA`
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
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OFFICE USE ONLY:
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:? Q ��
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MAST BE COMPLETE 8t FILLED IN TO BE ACCEPTED
9431 f-
qs �Gy ST. LUCIE COUNTY PUBLIC WORKS
�< BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
20R10 FORT PIERCE, FL 34962-5652
561-462-1553
By
APPLICATION for BUILDING PERMIT S� �UCiPf'n►mhr
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION 9�_
LOCATION/SITE ADDRESS: 272yi aCPRESSY
2. S/D NAME: ✓ 1a4ze SST 4T SITE PLAN NAME: pp
3. PROPERTY TAX ID#: l� a��
4. LEGAL DESCRIPTION (attach extra sheets If necessary):
5. PLAT 6. PAGE
BOOK NO.
7. BLOCK
NO.
6. LOT
NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
POUF rSCG� �!
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT / LEFT
02 SIDE 'SIDE: I3 g
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] 'RESIDENTIAL COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) r
13. DESCRIPTION OF PROPOSED USE:
14. Sq. FL/CONSTRUCTION: 102 G -aw 15. Sq. FL 1st Floor.
16. VALUE OF CONSTRUCTION: $
The value of construction is used to determine the amount of permit fees to be assessed. SL Lude County resenea tiro rlpht to question and/or modify the
Indicated value of construction B It Is de ambeted Co IM subrtitled tlpu ms are not earlsbtent with WmUar types of u morudion RCM%s. ff the value Is $2500
or more, a RECORDED Notice of Carrunencement rmrst be sutxnitied wBh this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME_ _ _ /CiC� 7rL /-!�17j1.6'iLL
ADDRESS: - _ o�7�� �ryf'0/ --T
CITY: • /"T/,�� STATE: zip
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: ��y} dg �U/�, 5/2 �/�/Q SO�T�1 �U CSC
ADDRESS: X.P�? / brJ 'd rsv .»
CITY: �2G 47'E
PHONE (DAYTIME):_
CONTRACTOR INFORMATION
STATE: esC Zip
ST. of FL REGJCERT f: A % J_g /p{! ST. LUCIE COUNTY CERT #: _ U
BUSINESS NAME: e706'16,d
QUALIFIERS NAME:
ADDRESS:
CITY. _ �TL�•�T STATE: r_C_ Zip -7
SHONE (DAYTIME): 17*7,21 FAX No. 7 2,q
1RCHRIENGINEER � �p �Zc��gB
1DDRESS: % U r/ se-oz a 2",9
:m: PO/L T S7
'HONE (DAYTIME): ( 1 7 [4 - `7 3 2 �/
ONDING COMPANY:
DDRESS:
ITY:
DRTGAGE LENDER:
DDRESS:
Ty:
STATE: &`L_ - zip -W3?S
STATE:
ZIP
STATE: 23p
VIPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days
fter 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 certiftt
capacity, if 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 sstandards of -all laws regulating construction-in-this-judsdiction.- 1-understai -
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEA:
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, acci
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 PF
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OI
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOF
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 ATTA HMENT• 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 all work will be done in comp!
with all applicable laws regulating construction and zoning.
ER/CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE \\
STATE OF FLO `
COUNTY O
The foregoing instrument ,knowled
J
t202, by
Aj
beforeme this dayo
v&1Lally
' no me or who
has produwIdentification. Sign# of Notary
Type or P nt Name of Notary
STATE OF FLORI
COUNTY OF
The foregoing instrument VMS acknowledged
before me this /0 day of 20 O , by
L (moo r,D • ,who is pally known me
or who has produced cation.
Signature Of Notary
Fry
Type of Print! ame of Notary /
CO
In AUDREYB.HUMPHREY Commission Number
(g881) ''� ..,y� _ MY COMMISSION# DD 190381 "
r�4ev'••. AUDflEY B. HUMPHREY
a.. •La EXPIRES: March 6, 20D7 (Seal) ' V,
V: MYCOMMISSIONgOD190387
'pt.R^„°`.•'' enneeaTmu Nowy PLm�u�e,wmers j, o•= EXPIRES: March 6.2007
t"•"'0: 8mhed Rw Notary PUNC Under em
P ,F:
r_t .
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEIjBUILDER THE OWNER MUST PERSONALLY APP
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.