HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMITOFFICE USE ONLY: 1i �� a J
DATE FILED: O j J a C%
PLAN REVIEW FEE: RECEIPT NO.: / PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
� Q
St. Lucie County Building and Zoning
h ti
2300 Virginia Avenue a L
F�OR1O SCANNED FL Pierce, FL34982-5652 G(
BY 772-062-1553 �eG�
St. Lucie County
APPLICATION for BUILDING PERMIT Gam, d
CERTIFICATE of CAPACITY/ZONING COMPLIANCE'"
PROJECT INFORMATION
1. LOCATIONISITEADDRESS:
2. PROJECT NAME: SIZE PLAN NAME: 1 V" 1 t:P
3. PROPERTY TAX ID #: D • CED V (/
4. LEGAL DESCRIPTION (attach extra sheets if necessary): I>Cgi.G 14A0.a�d the - in C QALN'c O -<_L l�
tYTtvrP 1 �t51 [ )I� Q9 G��21��cc j �,n N V P , vN rrm/-\m/vn -D J10mP1#
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRESlSQ FT.)19 LOT DIMENSIONS: ':h b4 X bb, 5I
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: -)U 1 Cx t / r t' vL
i a R S bsy Qf o yi>-- ::m C N-I
it. SETBACKS (ACTUAL) FRONT: WA BACK: �_ RIGHT SIDE:_ LEFT SIDE: NIIJ
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
13.
14.
ira
[I NEW CONSTRUCTION `J EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) t(�
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: 10 lT 15. SF. FT 1st FLOOR:
VALUE OF CONSTRUCTION: $ �oOO . uo
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 of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
NAME: ��a�r 1f -
CITY: i 111A J!U STATE:
PHONE (DAYTIME): (--)
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: _
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: G
BUSINESS NAME:
QUALIFIERS NAME:
CITY:
PHONE (DAYTIME): ()�
i
ARCH-IT/ENGINEER:
ADDRESS"' -
CITY:
PHONE (DAYTIME): (_)
STATE:
'AX NO J
STATE:
i
i S l6•_ '
1
D—� 1
I4-4
C ���,v GV �C�tiaie eJ
�/� ^ v7
,' A ZIP: I l Le-5 L U
Email:
)IF'FERENT FROM THE OWNER LISTED ABOVE, PLEASE
V
ST. LUCIE COUNTY
ZH':
Email:
AP
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP:
MORTGAGELENDER:
ADDRESS:
CITY: STATE: ZIP:
IMPORTANT NOTICE: Whdwa permit is -issued and it is not picked up within 60 days after notification
it will be voided and returned to you by' mail.
d
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 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 DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLOR
COUNTY OF
The foregoinmstrument was acknowledged.before
me this � day of 20 U ,
who is personally known X or has produced
as identification. - -
Signairm'Idt"Notary
Commission No.
DD LL959417
��iekW 204 19
�e
TURE
STATE 6F FLORH
COUNTY OF L J A 0
The forego Instrument was acknowledged bef]o(rre
me this ay of�Jn 20�,
by
who is personally known or has produced
as ides tr£ication.
afore otary
Commission No. Nk
t COHM.Mt9 KELLY
Commission k DD 959417
Expires February 14, 2014
8WedT1nTm8F9nN=a8Z3M019
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUH,DER, 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 OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #:
SECTION
TOWNSHIP
RANGE
I
MAP NO.
l•j
ZONING
LAND USE
LOT CV G %q
TAZ NO.
FLOOD ZONE,
FIRM MAP #
IST FLR ELi
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLP
LOT SPLIT
Before 111990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADONI
PERMIT
CODE
�`^'�
AREA
FEE
FEE
1 I
(RADON)
LIBRARY
PUBLIC BID
P
PARKS
IMPACT
IMPACTFEE
IMPACT
IMPACT
FEE
CORRECTION
FEE I
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
MISCELLANEOUSSUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING: LI.Aa/
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTEF4
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
�LJ//U
DATE
COMPLETED
p YL
INITIALS