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Home My WebLink AboutAPPLICATION FOR BUILDING PERMITOFFICEUSE ONL, t DATE FILED: S e: PLAN REVIEW FE RECEIPT NO.: 4014 ys CONCURRENCY FEE: RECEIPT NO.: PERMIT NUMBER: CERT. CAP. NO.: 13vSj o1(qf ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue SCANNED Ft. Pierce, FL 34982-5652 772462-1553 13Y St. Lucie County APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT 1. LOCATION/SITE ADDRESS: 2X00 A/ " /—f . ILL. �? �2 I -f- / 2. PROJECT NAME: 0617 oOA L/Ylf SITE PLAN NAME: 3. •PROPERTY TAX ID #: 14 0-s in m OQD 0-Q'D'DO 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 11. 12. 13. SETBACKS (ACTUAL) FRONT: ? BACK: RIGHT SIDE:_ LEFT SIDE: � - TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [� (S [ ] COMMERCIAL [ ] INDUSTRIAL OTHER CIFY) /4� DESCRIPTION OF PROPOSED USE: /2yl cylk—w -r41gt I c 14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR: 16. VALUE OF CONSTRUCTION: $ 0.71: m The value of concoction 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 ifitis demonstrated that the submitted figures are not consistent with similar types of construction activities. if the valuo is $2500 or more, a RECORDED Notice ofCommeaccmenl must be submitted with this application. SLCCD Vn� Form No; .: 001-02 frQc UPDATED 6/25109 OWNER INFORMATION �p n^ NAME: J-dw At m—( cONOa d , p c ADDRESS: n1�`�� CV /9/19 CITY: r , L / STATE: Imo- ZIP: PHONE (DAYTIME): �i� / p�- 6G-%� Email: cg o&/ ,fyQ Plot • r-oA 1 _ 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 ST. of FL REG.CERT #: C I3� y9 4S BUSINESS NAME: l.21:9piU dl.�k )1/41' QUALIFIERS NAME: �--0f1A?A ADDRESS: CITY: STATE: PHONE (DAYTIME): ( O -09Qj FAXNO. ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER. - ADDRESS: CITY: STATE: STATE: STATE: ST. LUCIE COUNTY CERT #: dJl W ZIP: 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 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 FIRSTINSPECTION. 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, OWNER OR CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this day of 20 by who is personally known _ or has produced identification. Signature of Notary Commission No. (Seal) The foregoing instrument was acknowledged before me this I S+ day of rn 6T— 20 L 3� by -ems A C/ e , ,. e who is personally -known — or has produced �— as identification. Signature of Notary Commission No. tL - emJVICbE L HEHOID MY COMMISSION k EE 082114 Bonded Thru Notary Public Undeffi NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR 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 inptructions see apRropriate permit checklist i i OFFICE USE ONLY BP #: 13 a 5 - d 1 G SECTION TOWNSHIP RANGE MAP NO. ZONING 4 1(� j� LAND USE {S M °° , 1 LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1T FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 111990 After 1/1990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE AREA FEE FEE RADON LIBRARY PUBLIC BLD PUB1C BLD PARKS IMPACT IMPACT FEE IMPA IMPACT FEE CORRECTION FEE GENERAL SCHOOL AD CREDIT Y N LAW ENF IMPACT IMPACT IMPACT FEE - FEE FEE FIREIEMS DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE IMPACT REQUIRED FEE [ VARIANCE FEE FEE I SPECIFY MECHANIC ROOF NON -CONFORMING MISCELLANEOUS SUBS ELECTRIC �� LOT OF RECORD FEES REQUIRED PLUMBING _ FEES DATE SENT TO ADDRESSING: / REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE D RECEIVED DATE ` V3 D COMPLETED INITIALS ! I 1 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 THIS 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. OWNER 0I17CONTRACTOR SIGNATURE OF 'bcowd-Cd The foregoing instrument was acknowledged before me this 6� " day of J l.Lr.-2 2013 by SSV\ LLG t—�tAf � ti`-; who is personally known L/or has produced identification. The foregoing instrument was acknowledged before me this U41 day of —T f\ 2 2013 , by 305r\LLCti who is personally known ✓or has produced as identification. Signature of Notary Signature of Notary "�:+'Y6'••. gVCKIEL HEROLD _ vVICKE L HEROID fAMMiSSIONEE08MyCMMISSIONEE08214 a Commission No. . EXPIRES: April 10, 2015 EXPIRES, April 10, 20 "•I...tya``' Bonded Thru Notary Public Underwadele ` landedThruNotaryPublicUnd • NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEWBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. OWNERBUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. For specific inptructions see appropriate permit "ihecklist. I