HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFIC
USE
DATE FILED:
► e �- a 59
DATE FILED: � PERMIT NUMBER: o"'
PLAN REVIEW FEE: C�_ RECEIPT NO.:
CONCURRENCY FEE:
RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTOED , C
E COG �1�v c�
St. Lucie County Building and Zoning 1 / 1w
2300 Virginia Avenue re ) �� 0-14
• ORIO Ft. Pierce, FL 34982-5652 M
.7i2-462-1553 l./�i, L��r'
V
APPLICATION for BUILDING PERMIT
CERT ICATE of CAPACITY/ZONING COMPLIAN�/yam
'ly o
PROJECT INFORMATION T „y.�„ Beach
1. LOCATION/SITE ADDRESS:
3y9 5_7
2. PROJECT NAME: 2 SITEPy/LAN NAME: L
3. PROPERTY TAX ID #:
4, LEGAL DESCRIPTION (attach extra sheets if necessary):
n
5. PLAT BOOK — 6• GE NO
3 i, 31 cat.
9. PARCEL SIZE (ACRES/SQ FT.): -' 3
SETBACKS (ACTUAL) FRONTYA"
7. BLOCK NO. S. LOT NO.
1i
LOT DIMENSIONS: �3 , bi
X gb.50
TYPE OF CONSTRUCTION (Check all appropriate boxes)
EXPANSION/ADDITION
COMMERCIAL
NEW CONSTRUCTION
RESIDENTIAL
OTHER (SPECIFY)
DESCRIPTION OF PROP'
fl
SQ. FT OF CONSTRUCTION: A �
16 VALUE OF CONSTRUCTION: $
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
15. SF. FT 1st FLOOR: t'r' G S t
The value of construction is used to determine the amount of permit fees m be assessed. 5[. Lucie County reserves the right to quesIf the tion andlor modify the indicated
value of construction if i[ is demonstrated that the submitted figures nre not consistent with similar types of construction acti SCANNED
$2soo o[ more, a
RECORDED Notice of Commencement must be submitted with this application. BY
SLCCDV Form No.: 001-02 n St. Lucie County
1k: _�
CERTIMCATIONG
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 n has
er
work rior to the issuance of a permit and that all
wiIl be pefformed to meetthe standardd work. I s of all laws regulati gthat no work or lc construction inntthis jurisdiction.iced 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 build ng permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
u
able Homeowner Association rules, bylaws or any covenants that may
which is in conflict with any applicrestrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
nc review: room additions, accessory
The following
structures (all
residential use.
building permit applications are exempt from undergoing a fur l concsubs atio s &accessory uses to another non -
types), swimming pools, fences, walls, signs, screen rooms, Y
NOTICE TO OWNER:
NOTICE TO APPLICANT:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE B
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
LENDER OR AN ATTORNEY BEFORE RECORDINEND TO OBTAING YOUR NOTICE OF LT WITH YOUR
COMMENCEMENT.
IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
SUANCF OF TIES GOOD ATTACHMENT:
T: AS A DELIVER CONDITION
OF IS
CONSTRUCTION LIEN LAW NOTYOU ICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
iOWNER OR CONTRACTOR SIGNATURE
STATE OF FLORID 1
COUNTY OF
The foregoing instrument was acknowledged before
day of 20 Z '
me this /1 \�'_- n Q Q
byI—
who is personally known _ or has produced
as identification.
Commission
A br
'>%ONTRACTORSIG.N�NA//T��URE
STATE OF FLOR l
COUNTY OF ►►► lll�// ��r��t
The forego[ g instrument was acknowledged before
me this forego]
of l t , 20J-hL
by
who is personally known or has produced
T BE NOTARIZED.
APPLYING FOR
NOTE: TWO BsUILDING PERMIT AREQUIRED* EACH SIGNATURE S AN OWNERBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
HtED FOR ALL OWNER/BUILDER APPLICANTS.
OWNER BUILDER AFFIDAVIT WILL BE REQU
For Specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #:
SECTION
TOWNSHIP
RANGE
I ,
�I
MAP NO.
(-J`.J✓`1
ZONING
LAND USE
L T CVG %
1� C]
TAZ NO.
FLOOD ZONE
FIRM MAP#
J� _J
1ST FLR ELV
q co/1a.,
✓`,
MAXHGT
5
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
1
HABITABLE
RADON
PERMIT
CODE
O
AREA
FEE
FEE
I
(RADON)
LIBRARY
IMPACT
PUBLIC BLD
I���,
PUBIC BLD
IM ACT
O�-
PARKS
IMPACT _
1
14 ffi
CORRECTION
FEE
l/
GENERALFEE
' SCHOOL
b8�
ROAD
l
CREDIT
Y
/ N 1
LAW ENF
1
IMPACT
•J�J
IMPACT
O1',
`iFEE
�1
IMPACT
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
533
REQUIRED
FEE
VARIANCE FEE
FEE
_
v
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
ADDRESSING: ! 12
DATE SENTTO —Qq—/
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
/�i
DATE
COMPLETED
INITIALS
( Y
OWNER INFORMATION
NAME:
CITY: J R (/STATE: v � G ZIP:
PHONE(DAYTIME):! 1=185�C Email: Vi�/� c e�P.Q//) • 60172
IF THE FEE SIMPLE TI OLDER (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): (_) i
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME: _
QUALIFIERS NAME: ,
I
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
ST. LUCIE COUNTY CERT #: ?�
STATE: O �l/CGaly ZIP: (!XC �
FAX NO.9VZ Email: l/'�f%�s6DTiPI &717
cc 5bt- a�— 7ait)Ecc ArRRVEcc®/cN��+E��
STATE:
STATE:
STATE:
A'
MI
AI'
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.
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