HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE USE ONLY:
BP #: 0603-0
OFFICE USE ONLY
SECTION:
0/
TOWNSHIP:
1
A.
0
r
RANGE:
��9E
MAP NO.:
/k /-5
ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP
IST FLR ELV:
MAX HGT:
*2
CST TYPE.
OCCP TYPE:
MAX. OCCP:
OF FLRS:
WATER.,
sP RINKLERS
STORMWATE
LOT OF REC M* 1190)
LOT OF REC (aftr 1/90)
I
LOT SPLIT
LOT SPLIT
REOD
APPRV`D
DECAL
NUMBER
LIBRARY
PARKS
PERMIT
IMPACTFEE
IMPACT IdE
FEE
REPORT
CODE
PUBLIC BLDG
IMPACrFFE
1,9
HABITABALE
AREA
RADON FEE
(RADON)
ROAD
)9
GROSS ROAD
CREDIT
y
N
TOTAL ROAD
IMPACrZONE
IMPACTIFEE
DUE
j?
IMPACT FEE
SCHOOL
CREDIT
TOTAL
IMPACTIFEE
SCHOOL
IMPACTFEE
FEJ
POUSJ�JE
e7l
/ / a-
FIRE FEE
9 �
MISC FEES:
TOTAL
'-'3
POUICEMREI
MISC. FEES
ADDITIONAL
[7(
SPECIFY.
TOTAL ALL
PERMITS
FEES
REaD
RE VMM
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE
INIT11ALS
DATE FILED: -3-q-D,5 — . - .
PLAN REVIEW FEE: RECEIPT NO.: TE91�HTNUMER: 050,5- D,390
dIMIDr d' AID WfS .
ALL INFO MUST BE COMPLETt 81 FILLED IN TO BE ACCEPTED
/\10(1
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE SCANNED
FORT PIERCE. FL 34982-5652 BY
(a 561-462-15W St. Lucie County
APPLICATION for BUILDING PERAUT
CERTIFICATE of CAPACITY/ZONING tOWIPLIANCE
PROJECT INFORMATION
1.
LOCATION/SITE ADDRESS: F-7- wet,-ro4,,
2.
SID NAME: tpwcnocozo /9/,t, SITEPLANNAME:
3.
PROPERTYTAXID#:
4.
LEGAL DESCRIPTION (attach extra sheets if necessary):
L073
ft,4,�o IS1015 ok t774-17e2-
5.
PLAT 6. PAGE 7. BLOCK
NO.
a. LOT
NO. 3
BOOK NO.
V
9.
lt)LI6
PARCEL SIZE: ACRES/SQ fT. . LOT DIMENSIONS
/Ji 6YO
10.
DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
6 LO
C- O/V C k4 te- gr-or-& g-r-ec-&o
11.
SETBACKS(ACTUAL) FRONT: S� BACK: RIGHT
f �- V SIDE
LEFT
SIDE:
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
'=Z)- 0
NEW CONSTRUCTION EXPANSIONIADDITION
INTERIOR RENOVATION
RESIDENTIAL COMMERCIAL
INDUSTRIAL
OTHER(SPECIFY)
13.
DESCRIPTION OF PROPOSED USE:
14.
Sq. FLIC'ONSTRUCTION: is. Sq. Ft. I
st Floor
16. VALUE OF CONSTRUCTION: $ 0 00
The value of constructioni is used to determine In amount of permit fees to be assessed. SL Lucie County reserves the right to Quesbon and/or modity the
Indicated value of construction It It is demonstrated that the submitted fgAw are not consistent with similar lyties of construction activities. It to value is $250C
or more, a RECORDED Notes of Cornmencement must be submitted wtIh Oft application.
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME:
ADDRESS: voo / y Z�/* 5-, Lo' U
CITY: '4e'1f6'1f 6TE: ZIP
PHONE (DAYTIME): 7U
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
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, ETC., not otherwise included with this building permit application.
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.
FEE SIMPLE TITLEHOLDER.
NOTICE TO OWNER:
FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
ADDRPq
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING. CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
CITY:
STATE: 23IP
YOUR NOTICE OF COMMENCEMENT.
PHONE (DAYTIME):
I I
NOTICE TO APPLICANT:
AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT. TITLE- AN
INTEREST THAT IS SUBJECT TO ATTACHMEN ; AS A CONDITION OF THIS PERMIT YOU
CONTRACTOR INFORMATION
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN
LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
ST. of FL REGJCIERT It.
clw— ST. LUCIE COUNTY CERT 0: �L _57/
BUSINESS NAME'
gl-� id I L-05"
OWNER'S AFFIDAVIT:
I certify that all the foregoing information is accurate and that all work will be done in compliance
QUALIFIERS RAMM
fi(- ex C-61f 6��
with all applicable laws regulating construction and zoning.
ADDRESS:
ly2r,
�)
'��
CITY:
#64off L- STATE: /Cc-'& mp 32 c�L
a� aL-,, (a, �4�
OWNERICONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
PHONE (DAYTIME):
(22)-, 5-&� FAX NO.
STATE OF FLORI A
STATE OF FL5W D
COUNTYOF
COUNTY OF
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDEM
ADDRESS:
CITY:
STATE'
STATE'
STATE*
23P
23P
ZIP
IMPORTANT NOTICE: When a permit is issued and It Is not picked up within 60 day.6
after notification It will be voided and returned to you by mail.
The foregoing in trument s ackno led ad
be re me this May of,;Z2 27 byg
S . who iE_p��Iown to me or who
has oroduced as identification.
. Type or Print Name of Notary
m z M FraTEM --I RM I I FM
_Commission Number
(seal)
The foregoing instrument was acknowl9dged
be me,this)—gfday of = 26)y
� by
who is per'so!d"NTY owntome
or�who has produced �—' as identification.
LiNDA C. GRANT
of Notary Notat Public, State of Florida
My comITI, pxp. me[. 10, 2005
LINDA C. GRANT 1 ITTL C(Imill- No. DD 005846
Notary Public, State of Florida Type of Print otary
My comm. exp. Mar. 10, 20 05�
Comm. No. 00 G05846 ' . Notary Public Title
(seal)
Commission Number
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 APPEAP
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.