HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT.f
bFFICFILED:- II: � (14f,
PLAN REVIEW FEE: 1 RECEIPT NO.: PERMIT NUMBER / ��
CONCURRENCYFEE: RECEIPTNO.: CERT.CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISI
2300 Virginia Avenue `
SCANNED Ft. Pietce,FL34982-5652 \
nv 772-462-1553 �_
t
St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: l J IV A ti co,-- ry [C. r R— , G I -34 j,
2. PROJECT NAME: C4 0DCI W t t v SITE PLAN NAME: z &r�� T] (LE s t -rr
3. PROPERTY TAX ID#: 341IT-%0Z—c�o1-1—c-:too—o
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): • Ti, P'(0 LOT DIMENSIONS:
10, COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11.
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[.] NEW STRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] ENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ OTHER (SPECIFY) S
t
13. DESCRIPTION OF PROPOSED USE: 2YE r i!/L —g t J ,(c lfflf Q4
-t-MEl' A1RA1-T0a,,)Ly As/4t97> pa-rZn./ir -n.10r
04- PeP-tit 2-r A;-7-t�^IpE-A sf<EA - S0C- 17 moo✓
14. SQ. FT OF CONSTRUCTION; 15. SF. FT 1st FLOOR
16. VALUE OF CONSTRUCTION: $ �� oti
The value of construction is used to determine the amount ofpemvt fees to be assessed St. Lucie Countyte arves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures am not consistent with similar types of construction activities. if the value�is 52500 or nig b, a
RECORDED Notice ofCommericcmatt must be submitted with this application APE 1/91,
SLCCDV Form No.: 001-02�p�'
1
t UPDATED 6125109
OWNER INFORMATION
NAME:
ADDRESS:
CITY:
STATE:
PHONE (DAYTIME):%( 3 4 z— i 1 6 -7 Email
M
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:
PHONE (DAYTIME): L_)
CONTRACTOR INFORMATION
STATE:
ZIP:
ST. of FL REG.CERT #: �w e< S`� J Z ST. LUCIE COUNTY CERT #: Zrp 2So
BUSINESS NAME:
QUALIFIERS NAME: 77b "
ADDRESS: 3Zi Z S ;r: C-- 1 2 --w �bS
CITY: - r% STATE: 'PI ZIP: `-�
PHONE (DAYTRI ffi): FAX NO-l7 Z -zS'X-- l.4,(Z Email: 5 t (. Fl_c r t a
ARCHIT/ENGINEER: i
ADDRESS
CITY:
PHONE (DAYTIME): L_)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
STATE:
AP
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.
! 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 concurreacy 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
CON ATTACHMENT: AS A DITION 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.
OR
STATE OF F]
COUNTY OF
The foregoing instrument was acknowledged before
me this�0� `( day of 0�
by cJor,
who is personally known or has produced
STATE OF R
COUNTY OF
The foregoing instrument was acknowledged before
me this�day of r, 20—IL
by ;Scat
who is personally known or has produced
as identification. 4 as identification.
nature of Diary ✓ RONY ptARRAFFIN ignstore or ary
Pp NOTARY PUBLIC r/7U ANTHONY MAF
Commission No (p 0 � STATE OF FLORIDA Commission No. E0 � l 6,46 a NOTARY PUBLI
al Comm# EE8798?5 STATE OF FLOI
N Expltes 313f2017 Comm# EE8796
Expires 3/3/20
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERBUILDER, THE OWNER MUST PERSONALLY APPEAR.TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THEI FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist. i
I -
OFFICE USE ONLY, <, " �P #s I ` -olho
SECTION
TOWNSHIP
RANGE
MAPNO.
ZONING
%!
v
LAND USE
�j-nn
/I Y `
LOT CVG%
TAZNO.
FLOOD ZONE.
FIRM MAP #
1STFLR ELV
MAXHGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER.
LOT OF REC
Before 111990
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
AVACTFEE
CORRECTION
PUBIC BID
IMPACT
FEE
PARKS
IMPACT
FEE
SCHOOL
IMPACF
FEE
ROAD
IINPA
FEE
CREDIT
Y
N
LAWENF
RaACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
—
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS -
REQUIRED
MECHANIC_ ROOF
ELECTRIC
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING: !/ /
REVIEWS
FRONT
COUkRM
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEN
VEGETATION
RijVIEW
SEATURTIE
REVIEW
MANGROVE
REVIEW
RECEIVED
►3
DATE
COMPR FTFf)
13
INITIALS
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