Loading...
HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATEa TOWNSHIP: SECTION: ZONING: I I LAND USE: FLOOO2014E. I I FIRM MAP II:. CST TOE: I OCCP TYPE: RANGE: LOT CVG If., iST FLR ELV: MAX. OCCP: Its Z015 DATE FILED: C? BP 4: PLAN REVIEW FEE: RECEIPT NO.. I�ERiVi]TNUl)�E}2: �-�ya" OLI CONCURRENCY FEE: RECEIPT NO.: CERT. CAP- NO-: ALL INFO MUST BE COMPLETE. FILLED l'N.TO 13E ACCEPTED ST- LUCIE COUNTY PUBLIC WORKS MFLRS BUILDING & ZONING DEPARTMENT 230D VIRGINIA AVENUE ' '`IORt�p FORT PIERCE, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CiVPACITY/ZONING COWLIANC'F 1 1 I SPRINKLERS STORIVIWA7E WATER: SEWER: R LOT OF REC (OM1190) LOT SPLIT LOT SPLIT LOT OF REC {Defr U90) REO'D APPRVD LIBRARY PARKS PERMIT ' DECAL - 1MPACTfEE IMPACT FEE EEE NUMBER PUBLIC BLDG '¢ HARB`ITABALE RADON FEE_ i REPORT -IMPACT FEE 1 CODE (RADON) Y N GROSS ROAD CREDIT TOTAL ROAD ' ROAD IMPACT FEE IMPACT ZONE IMPACT FEE DUE TOTAL SCHOOL- CREDIT% SCHOOL ' IMPACT -FEE '- ° ..` -- s?' iMPACT FEE ' FlRE FEE ' MISC FEES: TOTAL POUCEFEE _ .. . - POOCEIRREI ' ^ -- - MISC. FEES ' Y N TOTALALL ADDMO14AL SPECIFY: FEES PERMITS REO'D. ZONING ZONING . PLANS 'VEGETATION [ SEA A,IAh1GROVE REVIEWS TURTLE . REVIEWED BY 00WINING DATE [ COMPLETE .- PROJECT INFORMATION rr �w" 'I. LOCATION/SIT�Ej ADDRESS: i-Ce�- i(,�C..E� 2. SID NAME: LQIYt1 CJf�ez25 �tli7 SITE PLAN NAME; IYtt Yee 1 l .l[Ab 3- PROPERTY TAX 1D il: 4. LEGAL DESCRIPTION (allachexhasheelsifnece nary): C U, 7 0 I')ook 11�i t } 5. 3�-35 o-F 4 he �i hire �ecord s r� S+. -Luc le-e-vtAytty. 5- PLAT- 6. PAGE- - 7. BLOCK -B- LOT BOOK 9 2 —3 NO- S 140. . 9- PARCEL SIZE: ACRESISOFT. LOT DIMENSIONS 5 1D. DESCRIPTION OF CONSTRUCTION PROJECT ORWORKACTIVITY: I w. 11: SETBACKS (ACTUAL) FRONT_ BACK RIGHT LEFT ` SIDE, SIDE: 1,:5 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) ' NEW CONSTRUCTION [ j EXPANSION/ADDITION [ J INTERIOR RENOVATION RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ j OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 31ri IA P 14. Sq- FtJCONSTRUCTION: 15.. Sq. Ft. 1st"Floor 166. VALUE OF CONSTRUCTION: a a3i.'it(p. The Value of cdnshi clion is used to dele it the amount of pe t fees to be assessed- SL Lude County resesVes the right to que om and/or rnoc, the inflated value of'oo hbeliox if it Fs demons§ated.ttlatthe sutxnbed figures are not aXiSis[ent with shrplar typr of ca�shuc„`en ac0•n"EeS. It the vahieis-$2500 or`- 2 RECORDED N a0.5esc4men co of Canrnt must be submitled vnTb u is appbcatio . SLCCDV Form No,: 001-02 . OWNER INFORMATION: NAME: ADDRESS: Vt�V DV1 :Be ix k STATE: i 1 ZIP 33A2--� P1loNE(DAYTIME)= IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM TI1F OWNER USfED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLE VIOL DE R: ADDRESS: CITY: ,. Y tr Vf1C )D �. •••••��-. STATE: ZIP CONTRACTOR INFORMATION ��p ^' 5 , of FL REG.ICERT ir: C• p d� 5T- LUCIE _LN?Y CERT 0: BUSINESS NAME- 1���/ P hT�j'±Q VY1�rjI • ' I r QUALIFIERS NAME: _ADDRESS: .\:5 CITY: �.1�]] STATE- 7 33_41�o ZIP rr —r ``I K E M AN 'Erj I{ ARCR)TIENGINEER: IV l V/ ADDRESS: (oO0 �- �F IJIXIE HIGIAWJ 'AV CITY. (I IJ Oi �i �l}Tn I STATE: i L. ZyP PHONE (DAYTIME): I%h _�S9 a - 3 74 a BONDING COMPANY: ADDRESS:: CITY: MORTGAGE LENDER: ADDRESS: STATE: ZIP CITY: STATE: ZIP _- SCll'➢s !SSuet�e e;! is rot Yicke3 up a✓ithirr 60da •= after notification ill wiii be voided and Tet Trneti Ito you ty rnai'L This application is hereby made to obtain a permit to do the work and. installations as intlicaled, and as obtain a certificate of capacity, if applicable, for the permitted work I cerbfy that no work or installalion has commenced prior to the issuance r a permit and that all woik will be performed to meet the standards Of all laws reguta ling construction in [his juris diction. I understand that separate permits may be required for ELECTRICAL, PLUiv1BING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, ., not Otherwise -included with this building permit application TANKS, MID AIR CONDITIONERS, ETC - The following building permit app6r;ZtionS are exempt from undergoing a full concurrency review: room additions, accessory structures (at; types), swimming pools, fences, walls, signs, screen TOOMS, utility substations & accessory uses to another non- lesidenlial use. NOTICE 7Q OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN_ FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT TITLE AND INTEREST THAT 1S SUBJECT TO ATTACHMENT- AS A CONDITION OF THIS PERMIT YOU PROMISE IN GOOD FAITH TO DELIVERA COPY OF THE ATTACFIED CONS7RU'LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY )S SUBJECT 70 ATTACHMENT. CT10P1CT)ON OWNER'S AFFIDAVIT: I cerGly that at the foregoing information is accurate and lhaLall work -be -done -in -compliance - - — ---- -- - with -all applicable -laws regulating construclion and zoning. OWNE CTOR SIGNATURE CONTRACTOR SIGNATURE STATE OF F R DA - - - COUNTY OFM ( o10_C� The foregoing' insb anent was acknowied ed before me this � day of AUAY20GRib D�4V&- . � w o opersonbqy known to me or who' produced - asidenbrcafion_ Signature of Notary y Type or Print lame of �Iotary i9oiaty Public Title STATE OF FL RIDA COUNTY OF I yr I a ll The foregoing instrument was acknowledged before me this s_X0 day of VA114t., 2 ,by who is personally known to me . - ho has produced as ident�cation. Signature of Notary Q� (a36_1p•- Type of Prinf Name of Klotary Nolallolaa I Public Title - Commission -Numb "T aya Notary Public State of Florida Commission Number (seal) :° `: Kathy Ingersoll e` My Commission D045860a s e`W oraE :Kathy ary Public State of Florida «n� Expires 101232009 IngersollNOTE: lWO ( TI I c n�`ren10232009 mission �r>03 - 2) SIGNATURES -ARE REQUIRED_ EACH SIGNAT IF APPLYING FOR THIS BUILDING PERlv11TAS AN OYYNEibDUtLDER THE OWNER MUST TO SIGN PERSONALLY APPEAR THISAPPLICATION IN THE OFFICE ]LISTED ON THE FROPTT OF THIS APPLICATION. t 'OFFICE USE'ON.LY BP #;01 = SECTION 1b TOWNSHIP RANGE aq 91 MAP NO. K)A f � �/ ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE v J� FIRM MAP # ] Sr FLR ELV MAX HOT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER A SEWER FR �1� � SPRINKLERS STORMWATER LOT OF REC LOT OF REC (afterr � LOT SPLIT / LOT SPLIT � 1/90 1/90 REQUIRED APPROVED F(before ADMINST LIBRARY' I PARKS PERMIT VARIANCE IMPACT FEE IMPACT FEE FEE `1,� C� � REPORT 1 ' o PUBLIC BLD `�' HABITABLE RADON FEE CODE ` IMPACT FEE {� AREA ' �' v-i DON S�iDAb• 1 �Q.ii71. ' : GROSS ROAD PCepQ.I CREDIT N TOTAL ROAD IMPACT FEE ` [ IMPACT FEE IMPACT FEE .. DUE SCHOOL CREDIT Y N TOTAL IMPACT FEE SCHOOL IMPACT FEE DATEFILED: PLAN REVIEW FEE: RECEIPT NO_: cnNruRRENCY FEE: RECEIPT NO-: SCANNED BY , . St. Lucie County 010 PERNI►T N-OMBE7t. ALL INFO MUST BE COMPLETE U FILLED IN.�O BE CEPTED Ne e�+q.-han CO, r�ttl 7. J �Gy - ST. LUCIECOUNTY PUBLIC WORKS G _ - BUILDINR ZONING DEPARTMENT �- 2300 VIRGINIA AVENUE - OR1�p FORT PIERCE, FL 34982-5652 - 772-462-7553 Na reCzz,i pv �Ccr lx#i'l.:lri hOC ' " t" S%ke-��L"qKTION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COlVJPLIANCE PROJECT INFORMATION LOCATIONJSITE ADDRESS: 1 1 WyII 17 3L(qYs 2_ S!D NAME: Val 1Y1 fJr^eezes CllAb SITE PLAIN NAME: V6li Meze5 CIlxb 3. PROPERTY TAX ID#= �j ��4^^.t LEGAL DESCRIPTION [altarJrexhasheets ifnecessary)_ LO'� ff L71F�`� �0111f► CJP�QZeS Lt4b�.,`r 1 rrt- 1BoolC $q y_04e5. 3Q-35 aF4►,e*%61ic Qetords 4F ,�-r. Lucie -County.. b. PLAT. 6_ PAGE- - 7_ BLOCK B. LOT C BOOK 9 9' NO_ 2 —3 NO_ � NO. �J ' 9_ PARCEL SIZE: ACRESlSO FT. LOT DIMENSIONS "�J , x •, I O ` 10_ DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: Stv�ele-�nvvm\y KeCstcdev.ee ,v/ V 11_ SETBACKS (ACTUAL) FRONT: BACK (,� � RRIGHT� LEFT 1 J�1�— SIDE SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) s-- NEW CONSTRUCTION [ ] EXPANSIONlADDtT10N [ ] INTERIOR RENOVATION RESIDENTIAL COMMERCIAL [ ] INDUSTRIAL . [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: -mY1R{l� �e Stl�Q�1C �. r 14_ Sq. FtJCONSTRUCTION: Q�� .15-. Sq_ FL istFloor_ 16. VALUE OF CONSTRUCTION: $d,I D .a59 .°`A The valve of cdnshurton is used to determine the amount of Permit tees to be assessed_ St. Luoe Coun�j reserres the rtgtrt to ques we ir�dedvalueof•construepan.'rfR[sderno�s§ated.ihatihe submltedfigucesre anot co'it5istentvn-thstrraTartypes of conshuclFon ac&A'6e5_-N the vah+e'isS2500 _ w nwre, 2 REGARDED No_twe of Corrxnertce�nent roust Ue submitted vnlh ttds application_ - i v.+may- SL�TN Form T1o_: 001-02 . _ CERTIFICATION: OWNER 10FORMATION: NAME:. • ' ADDRESS: 1 CITY- !{��,� VU ion ',Be 0.0 Yl STATE: P r I ZJP. 3342.E P}IONE tDAYTIME)= l5c1l 5aJb� �000 IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN N. NAME AND ADDRESS BELOW. - 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 appricable, for the permitted work 1 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 maybe required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AND AIR CONDITIONERS, ETC., not otherwise .included witb this building permit application_ The following building permit applications are exempt from undergoing a full concunency 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 TWICE FOR IMPROVEMENTS TO 'YOUR PROPERTY_ IF YOU INTEND TO OBTAIN. cffy-.ADDRESS: FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING STATE ZIP YOUR NOTICE OF COMMENCEMENT_ - - ctTY: . PHONE (DAYTIME): ! I NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT IF. IT IS NOT YOUR RIGHT TITLE :AND INTEREST THAT IS SUBJECT TO ATTACHMENT AS A CONDITION OF THIS PERMIT YOU . PROMISE IN GOOD FAITHTO DELIVERA COPY OF THEATTACHED CONSTRUCTION LIEN C&CCONTRACTOR INFORMATIONPROMISE NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT_ ST. o/ FL REGJCER7 iJ: oC�-+��*•-1 �i.: ST. LU,CIE CODNjY CERT q: BUSINESS NAME: �:���X' Q WIe rJ - _ OWNER'S AFFIDAVIT_ I certify that all. the. foregoing information -is accurate and -that -all work Will be done -in- compliance-, OUALIFIERS NAME. -^�.y� ` with all applicable laws regulating construction and zoning. ADDRESS:-ZLZ� uQ�T 1LL_� CITY_ �' W.jr%+0tn - QL' Iry STATE: ZIP 3342.E "-4 " �CC- r I t ` —t �NE ONTRACTOR SIGNATURE CO RACTOR SIGNATURE PHONE (DAYTIME): I 61) D36- 1 b6-7 FAX NO_ SP1-- STATE OF 1DA STATE OF FL$R`IDA_ _ ORE t' /�' r COUNTY O��R CJ� I COUNTY OF dim )tie VI ARCHITIENGINEER: _ ORE fJ KI AN - F-14 G I N E E 9 1 W Ca ' , The foregoing- instrument acknowledged The foregoing instrument was acknowledged. ADDRESS: ' ' ' OO S • I X I E H 1 C. IH W AV �•'y before me this day of - 200$], by Qjo� . before me thisaa day of IF-� ., 20�, by 60C A RATD M . STATE: L 2jp S, who is personal r known tome or who I ►A who is personally known to me CITY: CC/ 1 �' fi produced lifieation_ o whohas r : PHONE IDAYTTME): r5Gb ?jqo� - 3746 - P as iden' cation_ Sign to o o ary gn e o Notary BONDING COMPANY: N%A �-�� NOTARY PUBLIC -STATE OF FLORIDA _ Ton a McDonald NOTARY PUBLIC -STATE OFFLORIPA ADDRESS;; Y I'�KlJ� T e Print Name of Nota Commission # DP452656 Tanya McDonald CITY- STATE Type of Print Name of Notary - _ Dp � Expires: JtILY' 19, 2009 - Commission # DI'>s}52656 Notary Public Title Handed Thru Adand, Bonding Ca., Inc. *Expires: JULY_19,. 2009 Notary Public TiOe @endFdTWUAdaitYe➢vridingPo,,Inc. MORTGAGE LENDER - Commissions Number Commission Number ADDRESS: - (seal)- (seal) CITY_ STATE :- ZIP..- ` NOTE: TWO (2) SIGNATURES ARE REQUIRED_ EACH SIGNATURE MUST BE NOTARIZED_ Ia1Tl 0it A"AifDliE�s:lrVhen,a:g►ernni4.isissued andzitisnoi-picked TagvsriihinGo.dp+ IFAP��NGFOR THIS BUILDINGPERMITASANOWNEPBUILDERTF)EOWNERM.USTPERSONALLYAPPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF T111S APPLICATTON. after notification it will be voided anal retomed 4o.yoti b}► mail.