HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICEMSEONLY:
DATE FILED.
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER
CERT. CAP. NO.: -
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
IE
St. Lucie County Building and Zoning
"(Ifl 2300 Virginia Avenue
�ORO SCANNED Ft Pierce, 6 -1 582-5652 1 n �/
BY 11 V NV
St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITYIZONING COMPLIANCE
PROJECT INFORMATION 3y49 O
1. LOCATION/SITEADDRESS: t 32bZ — i3a08 60 e;I'IM Ca - +L
2. PROJECT NAME: !t'1 , LA- L m k a SITE PLAN NAME: rn" i i L6:
3. PROPERTY TAX ID #: 'i q 21 801 0d0 Q 000 or
4. LEGAL DESCRIPTION (attach extra sheets if necessary): pool o uk
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): iv c LOT DIMENSIONS: i..t 0--
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVrrY: �, 2
11
12.
13.
14.
SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: _
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[A- OTHER (SPECIFY) --�)t r v v 1 a
DESCRIPTION OF PROPOSED USE: N a
SQ. FT OF CONSTRUCTION: tv a 15. SF. FT 1st FLOOR: l-j . a -
16. VALUE OF CONSTRUCTION: $ 1 .SOO OO
The value of construction is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the right to questioa and/or modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
NAME: 011 Lr— 4- m K� v A «
ADDRESS: 13Zo2- 13;L08 ko+60u O F
CITY: Pa. t . C: � H STATE:
PHONE (DAYTIME): (�7b Z Z 3 0(.044
^^23P: 3'1990
Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
PILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: YYl i
ADDRESS: S eA a.b
CITY: STATE:
PHONE (DAYTIME): (�
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: C Bc- 12 Sa 3 8 8 ST. LUCIE COUNTY CERT #: a 35
BUSINESS NAME: IA.) a 11 u C n $� u � - on —i"
QUALIPIRRS NAME:
ADDRESS: � O LSO yC 1 S3-f --
rTry %, a S a I ..c! w o - STATE: F L 21P: 3 Wl R 02
PHONE (DAYTINIE): =Z 2 Z 3 0(2 0d FAX NO. -I-12 Z Z 3 a(. 84 Email: A 61( w
�-cu,.s;.mac}: on. coM
ARCHI VENGINEER: C: h cv i-c'; I) o d- A L U
ADDRESS: 18 3 5w /N 6..I. r c ./
CITY- 5Au,4 rL STATE:
PHONE (DAYTIME): a-1 A- 2 2 O- H L. O I
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
F`il "t
VAIG
Rr
EMPORTANT 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.
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 concunency 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
SCANNED ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
6Y GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
St. Lucie County
OR CONTRACTOR
STATE OF FLORIDA
COUNTY OF Al . I a
The foregoing instrument was acknowledged before
me this % day of a fJr ; 20 o q .
by�y I � Q � I� I
who is personally known --Zor has produced
�� A FL
RACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF Inn or #'ti
The foregoing instrument was acknowledged before
me this day of Q Vr ; I 20 0 9 ,
by'-Z ti_
who is personally known � or has produced
as identification. as identification.
Signatt f No Signature
tiff; ( PAa�n•RICIA JONES Commission No. �nLl
Commission No. _ .._ ptp^ilMMiSSION#DD723038�; 'PAiV-Y'A JONES
EXPIRES October 08, 2011 '� . MY COMMISSION # DD723038
(407)398-0153 r_ M4a%t S0-M9.MM EXPIRES OctoberOB,201t
407 3 CA FI' - N
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST B
THIS BUILDING PERMIT AS AN OWNER/BUIIJ)ER, 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 OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #: 4
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CV G %
TAZ NO.
FLOOD ZONE
FIRM MAP #
In FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Befm 1/1990
LOT OF REC
After 1/1990
LOT SPIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
(RADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BID
IMPACTFEE
CORRECTION
PUBIC BID
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIREIEMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC— ROOF _
ELECTRIC _ GAS
PLUMBING _ �A
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
or
DATE SENT TO ADDRESSING: _J__J
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
/ O
DATE
COMPLETED
INITIALS