HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE USE 'ONLY: DATE FILED: q
PLAN REVIEW FEE: RECEIPT NO.: �I_=50 PERMITNUMBER: —&L- oaXY
CONCURRENCY FEnE* RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
SCAN J O
N ED Ft. Pierce, FL 34982-5652Ie�
$Y 772-462-1553 �S 0
St. Lucie County ("C0'P6()
�_ _.__ 1
APPLICATION for BUILDING PERMIT ` r' " "" `
CERTIFICATE of CAPACITY/ZONING CO1VI] L ANCE
PROJECT INFORMATION (�(� lace, ,Vr
1. , LOCATION/SITE ADDRESS: _�j 6 C( I Aw Gti'JI Dr
,7�, e 3 y � d
2. • PROJECT NAME: SITE PLAN NAME:
z
3. ® PROPERTY TAX ID #: ti HA a-
4. ® LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. S. LOT NO.
9. (A PARCEL SIZE (ACRES/SQ FT.): 0 . 3 LOT DIMENSIONS: sf s% Fr./4 ] 9 s - 1 a s' a
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK" ACTIVITY: SJ, a d .
sq F1 w t d NO [_ ] E e elt r r o ✓1
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12. / TYPE OF CONSTRUCTION (Check all appropriate boxes)
[/f NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14.0 SQ. FT OF CONSTRUCTION: D 15. SF. FT I st FLOOR
16. VALUE OF CONSTRUCTION: $
The value of construction 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 orconsuuction ifitis demonstrated that the submitted figures are not consistent with similar types of construction activities. If the valuc�is S2500 or morn, a
RECORDED Notice ofCommenccment must be submitted with this application.
SLCCDV Form No.: 001-02
t
UPDATED 6125109
NAME: y vvvb�-
ADDRESS: /Cs q T#µ/ met D/—
CITY: /' — to-1 Z — — </— STATE: I/ ZIP: CIS
PHONE (DAYTIME): (--) Email:
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 it:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME): (_,
STATE:
FAX NO.
ST. LUCIE COUNTY CERT #:
Email:
ZIP:
ARCHIT/ENGINEER: 1 QYt0/'y2" C rva1 `4'.) 1 !1 -
hDDRESS: c�6 d ly ✓ 15 4� "J5 I w P JL — l
blTY: 4)lc/I.AW STATE: %I ZIP: 32 72-C
HONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY: — — —
STATE:
-- — STATE:
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
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 DELIVERA COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
b 24:
R CONTRACTOR SI ATURE m CONTRACTOR SIGNATURE
STATE OF FLORIDAR " 0
STATE OF FLORIDA
COUNTY OF 145"i m COUNTY OF
om
The foregoing instrume as acknowledged before va The foregoing instrument was acknowle d before
me this day of .20 � a m me this day of 20�
by by
is personally known _ or has produced who is ersona11
G • i�a��� 7� �F9 f
as i e tification.
Signature of Notary / (/ Sign re of Not
ary
or has produced
as identification.
Commission No. (Seal) J2ommission No. (Seal)
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 THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL O WNERBUILDER APPLICANTS.
For specific in tractions see appropriate permit heekiist. }
HI OFFICE USE ONLY Bp #: jz__t:u- 0 6vd'yp
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZNO.
FLOOD ZONE
FIRM MAP #
1 s FLR ELV
MAX HOT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
"'1
AREA
FEE
FEE
O
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BID
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
FEE
GENERAL
'SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC_ ROOF _
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
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
RECEIVED
DATE
COMPLETED
INITIALS
I I ! ! f !