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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY: `BP# g, `66 035'90 OFFICE USE ONLY SECTION: - TOWNSHIP:- 2 ." : <RANGE: n ZONING:. ._ - LAND USE:-, -. LOT CVG W. TAZ NO. ` a- FLOOD ZONE: FIRM MAP#: 1ST FLR ELV- MAX HGT: CSTrTYPE OCCP TYPE: MAX. OCCP: # OF FLRS: WATER:. - _ _ -,SEWER- . SPRINKLERS STORMWATE' R LOT OF REC Met I=) LOT OF REC (attr 1190) LOT SPLIT LOT SPLIT - REO'D - APPRV'D. - DECAL - - LIBRARY. PARKS �. �• _ PERMIT - NUMBER IMPACT FEE IMPACTFEE ,/ / FEE REPORT PUBLIC BLDG HABITABALE RADON FEE CODE /� IMPACT FEE AREA (RADON) Y N ROAD GROSS ROAD 'C/ TOTAL ROAD IMPACTZONE IMPACT FEE - IMPACT FEE DUE / /,. SCHOOL. CREDIT TOTAL-- IMPACT FEE =SCHOOL _.. .... a ,. .,: _, .:. _. ._w : •: _IMPACT FEE..:; POLICE FEE FIRE FEE MISC FEES: TOTAL , POLICEARE/ MISC. FEES Y N ADDITIONAL SPECIFY. • TOTALALL :,. PERMITS FEES REOD REVIEWS ZONING ZONING PLANS VEGETATION .. SEA MANGROVE REVIEWEDBY EXAMINING TURTLE DATE r1 j I -1 o � C � OMPLETE C2 - DATE FILED: /a- 0TV / PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:C0�1 CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL -INFO MUST BE COMPLETE a FILLED IN TO BE ACCEPTED D � RORIOP ST. LUCIE_COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT 23DO VIRGINIA AVENUE' ' FORT PIERCE, FL 349112-5652 561-462-1553. AP'. `- APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE SCANNED PROJECT INFORMATION' By 1. LOCATION/SITE ADDRESS: -'�7r/9 USA`/ /Uoi27i� St. LI1riPr;nnr7_fi/ 2. S/D NAME: SITE PLAN NAME: l 3. PROPERTY TAX ID #: Py.701 .S> / oo 4. LEGAL DESCRIPTION (attach extra sheets it necessary): 5. PLAT 6. PAGE BOOK NO. 7. BLOCK 8. LOT NO. NO. 9. PARCEL SIZE: ACRES/SQ FT. .?�i2� LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTNITY 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT / / A- SIDE SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ J EXPANSION/ADDITION [ ] INTERIOR RENOVATION:,: [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL I-] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: L5,f�,E4e_ C�TrGl2 S/GM 14. Sq. FLICONSTRUCTION: �� ��- / 15. Sq. FL 1st Floor: 16. VALUE OF CONSTRUCTION: $ /CL� m The value of construction Is used to detemim the amount of petmlt fees to be , SL Lade Candy reaavn on d9fd to question wAtor moray the Irr6®b'value of eaobudim Ifit is dencmtraled that #m subdtbd fipuea ate not corybtent wltb skr9w typos of =n ruicb -acam". If M.vaite 4 52500 or mac. a RECORDED Notice of Cat must W atrhmitied. WM tl gVk2ftr:' SLCCDV Form No.: 001-02 CERTIFICATION: OWNER INFORMATION:" This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certific .. NAME: ,S�JI��iA2 5'�� l��Y�po �1Ev�� i mac, capacity. .if, applicable. for the permitted. work:. I certify that no work or installation has commenced prior to the:issuance of a ;- _ADDRESS: --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, HEA cITM'�� 9T STATE: %C- zip 3�G 3 TANKS, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application. - PHONE(DAYTIME):1 _ _ i — --The following building permit applications are exempt from undergoing a full concurrency-review: room additions, acce IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS ,jAryetureS (all types), swimming pools, fences, walls, signs, Screen roods, utility"substations & accessory uses-to-anothe: BELOW. - residential Use. FEE SIMPLE TITLEHOLDER. NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT-IN,YOUR-PA ADDS° TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OE Cm,. - FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOR STATE: ZIP YOUR NOTICE OF COMMENCEMENT. PHONE (DAYTIME): 1 r 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 CONTRACTOR INFORMATION PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. ST. of FL REGJCERT t: C T mop / ST. LUCIE COUNTY CERT f: S«'�S' m6c , OWNER'S AFFIDAVIT: I certify that all the foregoing BUSINESS NAME: �7dy L./O - rtdy information is accurate and that all work well be done m`complf QUALIFIERS NAME d©1V.4(V with all applicable laws regulating construction and zoning.. ADDRESS: CITY: T STATE'- ZIP 3y`l9 7 OWNER/CONTRACTORSIGNATURE CONTRACTOR SIGNATURE PHONE (DAYTIME): 7 7aI 8 3 — � 4 G FAX NO. 7 7 ;:t — a 8 3 . — `170c/ STATE OF FLORID STATE OF FLORIDA COUNTY OF , ARCHITTENGINEER. �O�/u L/• Cr2FS/�%F_C� J�E COUNTY OF The foregoing instrumentP m The foregoing instrument was acknowledged - ADDRESS: 7 ��GI cS� ,E'Jl6 e,� ,¢rl.� , fore me this .day o�c.QGC, fore me th' day of,, 2(kJ,_, by CITY: �TiJ 4 //Zr " STATE �L nP • who is persoo n t o is personally known to me has produced or who h roduced as irientlfication.,PHONE (DAYTIME): rof fYi o 3Signature o l/ Signature of tary BONDING COMPANY: h( (J.- �� a>�I-K. ADDRESS: Type or Pri 901ame of Notary Type of Print Nfime of Notary Crrr. STATE ZIP Notary Public Titie Notary Public Title MORTGAGE LENDER: /�� - _ er AUDR El'B.HUMPHREV ADDRESS: - " ' W, MY COMMISSION I DD 190367 ._ MV COMMISSIO ( �'_ EXPIRE&marob6,2W7 .- N#DD19 -.- 9o�edthu Nola? P'v. Um-' M1ers - (. ,FBI apc �XT7nu No"March B 20077 , �`' m7Pub4'c Un�e CITY: STATE- - . 23P '+�,'P M, M'rAers _ NOTE TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERMUILDER, THE OWNER MUST PERSONALLY APPI IMPORTANT"NOTICE: When a permit is issued and It Is not picked up within 60.days TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. after notification it will be - _ - . voided and returned to you by mall.