HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT,,PEKE USE ONLY:
DATE FILED: a y
PLAN REVIEW FEE: RECEIPT NO.: .
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.: _
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 V rgWaAvcnue
Ft Pierce, FL 34992-5652
772-462-1553 Q C
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: L
EAGLE DW.
/--/3 S/fs/
2. PROJECT NAME: AaAlria i t/
SITE PLAN NAME:
d iiu
3. PROPERTY TAX ID #: /3/2, Soo 008 D e d
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
g. PLAT BOOK /,? 6. PAGE NO/�� ,4.16 D 7. BLOCKNO. &. LOT NO. 83
9. PARCEL SIZE (ACRES/SQ FT.): 3 LOT DIMENSIONS: I S% 9 9 8
10. COMPLE
TE DESCRIPTION OF CONSTRUCTION PROJECT OA�Rj WORK ACTIVIV
/"xlifiT/LvLf ITY
Z,6 s /-&0 TZo�v � �JrD/G�- L
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ I RESIDENTIAL [ I COMMERCIAL [ ] INDUSTRIAL
1 1 OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: l I/TwG i7��ir `
14. ' SQ. FT OF CONSTRUCTION: 9 S �� 15. SF. FT 1st FLOOR 2g9 s1 /
16. VALUE OF CONSTRUCTION: $ / /�� 307 55�
The value of construction is used to determine the amount ofpermit fees to be assessed. St Lucie Conoty.reserves the right to questionaod/or modify the indicated
valma of construction ifit is demonstrated that the submitted figures aranot consisteut,with sim0u WM of construction activities. lfthe value is U500 cr more, a
RECORDED Notice ofCommeac=mt mast he submitted with this application.
SLCCDV Form No.: 001-02 SCANNED
BY
St. Lucie County
UPDATM 60109
OWNER INFORMATION
NAME: -aF d r47' 1e,1A- ///8!/MR/1V
ADDRESS: D L10 Dig,.
CITY: STATE: ZIP: sc,�
PHONE (DAYTIME): �) �IoJ O ��1 Email -
IF THE FEE SAMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SAMPLE TITLEHOLDER:
ADDRESS:
CHy; STATE: ZIP:
PHONE (DAYTIME): U
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: C'Ig L / LS�S/% �S� ST. L1UCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME: Adz%lD �oLAd l/
ADDRESS:// O % /✓/Jds i R �At /�F Ti
CHy; 'a /G2c< STATE: G11 ZIP:
PHONE (DAYTIME): U H 6 % O Z7 D FAX NO. -/6 7,0 L 7 / Email: L�0✓/Cv GeJI6 QevP Us 4 .
ARCHTP/ENGINEER:
ADDRESS: 9 S
PHONE (DAYTIME): 9L 10761
BONDING COMPANY:
ADDRESS:
CITY:
STATE:
MORTGAGE LENDER -
ADDRESS:
CITY: STATE:
FAr
Mr
MORTANT 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, BEATERS, 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. Pease 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 JOBSfH'E BEFORE THIN
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 ,yIjPACHMENT.
SIGNATURE
STATE OF FLORIDA
COUNTY OF. S / � ZF
The foregoing instrument was acknowledged before
me this Z� day of
by 17�1Ti nr 0
who is rsonal known _ or has produced
A ) as identification.
Signs,s6re of Notary
Commission No. ,`:�'.. ';`rn W. Pq�',
„sion #�tl 9/8391
ff
s April 22, 2014
-� ;v?ryFainlrsua�8003BNO1B
SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
�
me this day of l , 20Y�6
by
who ' ersona y own _ or has produced
✓-) asidentiifcation.
Signature of N tary
Commissio BETTYW.P. 0E
� mk2,Ai4
A' a Ey.gi `s A111C < i i
a, f.� lw . 'o •r mswawe80034.7019
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 OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
rY
SE ONLY
�.
TOWNSHIP
3 f
RANGE
3
MAP NO.
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LANDUSE
LOT CVG %
TAZNO.
FIRM MAP #
1STFLR ELV
MAXHGT
OCCUP TYPE
MAXOCCUP
# OF FLRS
_
SEWER
�' (� �'
SPREQUERS
i
STORMWATER
LOT OF REC
Before 1/1990"
/`
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BID
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENT
IMPACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
—
DRIVEWAY
FEE
ADMINIISIRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC_ ROOF _
ELECTRIC GAS
PLUMBING _
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
COMPLETED