HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT90;CE USE ONLY: J ,—'
DATE FILED: qI
PLAN REVIEW FEE: JULI RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
cERMITNUMBER.
ERT. CAP, NO.:
as -6a �q
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
' Ft. Pierce, FL 34982-5652
772-462-1553 SC,9N
St 4& &k 0
APPLICATION for BUILDING PERMIFe CoU
CERTIFICATE
�&�D
1. I OCATTON/SM ADDRESS:
of CAPACITY/ZONING COMPL
PROJECT INFORMATION
L&a is F6r6mr 12-%olcie '13tvd., Pal,, C++-1, FL 34
2. PROJECT NAME: ITC,000tA r R t d ge SITE PLAN NAME: N 01r+'t% 1
3. PROPERTY TAX ID P. LI s-1�.5—^^^¢rT�+�=a --IDA-
WAIk
4, LEGAL DESCRIPTION (attach extra sheets if necessary): t-KV!oour I4,Ajt1--r14T 3—bOtt wuvtp- t eft
ns i or r 4Ir-lbyy
5. PLAT BOOK Oct2. 9 6. PAGE NO. U'. b 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): S 3.4 V /K LOT DIMENSIONS:
10. - COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: ifs O 0 t" ^raj
- Lg r I.v A k twj lTl4 Novi / nA r L& 42 t -T6JL L 57vl t: t.o
ix.iat STDfJ �ArD N � It1 Vi'1 i�'f-l-t�l'ilniS�� •ri�-ti
11. SETBACKS (ACTUAL) FRONT BACK: RIGHT SIDE: �.� LEFT SIDE:`
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
(I NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIORRENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
OTHER(SPECIFY) r�OeAa .9•4tW-utS g-^tf`t-rj L AdA -
13. DESCRIPTION OF PROPOSED USE: Al b''W um-� S-140
14. SQ. FT OF CONSTRUCTION:
16. VALUE OF CONSTRUCTION: $ � S B co
I5. SF. FT 1st FLOOR:
The value of construction isused 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 consWction if it is demonstrated that the submitted tigurca arc not candstcru with similar types of construction activities. If the valueis $2500 or more, a
RECORDED Notice ofCommrnccment must be submitted with this application.
SLCCDV Form No.: 001-02
t UPDATED 6125109
X
��a4' f U IQfS
•OWN ER4NF.ORMATION'-
NAME: IaVbowr gt'djp Prune,44 UWncvs ftuc.1?-,mac.
ADDRESS: f Lboo l-lar boor grdae f3W.
CITY: yGI rh C; ±1 STATE: F L zip: 34 95 -0
PHONE (DAYTIME): (1� 23` - 3OD o _ Email: C% refd E h4 c/- • �f5
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 #: 'LM, 1 SD 2X1 ST. LUCIE COUNTY CERT #:
BUSINESS NAME: 2 WUtA MAC.
QUALIFIERS NAME: N11L.V1 Lt2,1 G. \e Md(A
ADDRESS: 2•\'L 9 - US 1�l A- ) k i
CITY: �e� \� QS STATE: F(_
PHONE (DAYTIME): (501) 143 - 06167 FAXNO. 561-143-1-M Email:
ARCHIT/ENGINEER: f .,de�Oyy
ADDRESS:� W•,V' �• S '�%. C4w(daa!>j
CITY: � STATE:
PHONE (DAYTIME): 6' as 3 - 5
BONDING -COMPANY: —
ADDRESS:
CITY: STATE:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE:
2`6TO 1
ZIP:
ZIP: 3Y S9 Y
ZIP:
ZIP:
UZ3' 1A
IMPORTANT NOTICE; When a permit is issued and it is not picked up within 60 days after notification
it will be ov ided and returned to you by mail.
t
i
i
CERTIFICATION:
C°(„�ry F
This application is hereby made to obtain a -permit to do the work and installations as indicated,. and to obtain a certificate a p ty,
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. Lucia 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 say 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 anyrestrictions 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 zooms, 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 WITHYOUR
LENDER ORAN 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 FLORIDA _ ' ` _
COUNTY. OF ?q\� OAWI
The foregoing instrument was acknowledged before
methis ,�dayof MAALV 20 l`i
by Mkr_)Ix to 1i�1ew>4tn
who is personally known V11 or has produced
as identification.
iiA E�—
Signattue of Notary
{ MELANIEQUINN
ColmldSsloa No. n �u -` ;.= (3 MMSSION N BE 170290
EIiFIRES: May 17, 2016
Bonded Tlw No?arypubticUMeivni?m
CONTRACTOR SIGNATURE
STATE OF FLORIDA ;i,,
COUNTY OF ?a\ WIX
The foregoing: instrument was acknowledged before
me this -1 `day of VIA -A -A U1n .20 0
by IM UJIIJA Rb\ e_VMA fi VA
who is personally known ✓ or has produced
p Pn as identification.
UV�la�o LSD
Signature of Notary , _
Commission No.
MEIANIEDUINN
111WSSION B EE 170290
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACII SIGNATURE MUST BE NOTARIZED, IF APPLYING FOR
THIS BUILDING.PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR.TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE; FRONT OF THIS APPLICATION.
OWNERBUILDER AFFIDAVIT WILL BE REQUIRED FORALL OWNERIBUIIDERAPPLICANTS. i
For specific instructions see appropriate permit checklist.
Aw
OFFICE USE ONLY #e
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE.
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 111990
LOT OF REC
After 111990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
(RADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BID
IMPACT FEE
CORRECTION
PUBIC BID
ACT
FEE
GENERAL
PARKS
IMPACT _
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
WACT
FEE
FRREMMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF _
ELECTRIC GAS _ '
PLUMBING _
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
TO ADDRESSING: ! /
F
FRONT
COUNTER.
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW,
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
[N]TIALS
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12(oo`o ►-04Wu4�L- F—OAe F�VQP,
OWNER INFORMATION C • ?7Z - 19?3 -COOTS Y'.m at (a Vr'K
NAME: RPAL f5burL �IPe�1� Yaoler C_aVtiTIV4_CvuaGS� Aryszbra,Rt
ADDRESS: l Z (coo
CITY: & M STATE: FW ZIP:
PHONE (DAYTIME): c-a3� 33(0 - 30o a _ Email: %r• P � o h�`(� GL ' 9)
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERED f FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER
ADDRESS:
CITY:
PHONE (DAYTIME): (_-)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME: e
QUALIFIERS NAME: �JO�r� �,- �✓w�t�
ADDRESS: I3`e TNIJZ`e PQJ"'JA
CITY: A IN P IT,01- f,
PHONE (DAYTIME): 5 _ 6-75- 70'
ARCHIT/ENGINEER:
STATE:
ZIP:
ST, LUCIE COUNTY CERT A. O- 311 L14
G.v..nG 9 r ve..0�•ttiL, ►IJc•.
FL, cyL-t.t3A• ZIP:
Email: C /tee lU�01 '+
t sett. - N e
ADDRESS: 40q 5 W 64d Fj'w + rwvgz
CITY: SUWA_ K STATE: FL •
PHONE (DAYTIME): (i1� Z z �' • g $ 3
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.
. afr5
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, TIME, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE 1N
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER OR CONTRACTOR SIGNATZbeforeThe
OR SIGNATURE
STATE OF FLORID %E OF FLORIDA- ( L
COUNTY OF �j Lt (motTY OF v
The foreg
oing instrument was acknowleregoiingginstrument was acknowledged before
me this b day of ✓i ta/ s V ^ day of _ ZO I iby aSSe� 1 e' d A /1 L'. Ali �✓ �5
who is personally known �or as produced who is personally known ✓ or has produced
asidentifieation. as identification.
store of Not Si rat re of Notary
F 0 rl'okla�
Cotnmisslon . F b`II y ""t7� sal) sstonNo.'
,gel LAUNIE C. SNYDEN `"°""•••
: Notary Public =State of Florida: UP s LAURIE C. SNY
•e ' : Notary Public • State
ig'r• 0.5 My Comm Expires Aug I.2017 Mk Comm Expires At
Commission N FF 4
NOTE: TWO (Z) SIGNAT EA Sli�N MUST BE NOT z APIaLiNiNC6F0IE
THIS BUILDING PERMIT AS O OWNER MUST PE •
THIS APPLICATION U THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. p
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
, i r
For specific in)tructions see appropriate permit �heckiist.
;
i I I
Fkaidat
1.2017