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Home My WebLink AboutAPPLICATION FOR BUILDING PERMIT_ 1 N/oW4 Y <� ~ � 1 L OFFICE USE ONL.Yf) DATE FILED: (/� PLAN REVIEW FEE: _ RECEIPT NO.: RECEIPT NO.: PERMIT NUMBER CERT. CAP. NO.: - ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2Fie Virginia Avenue 982-56 _ ^ SCANNED Ft. Pierce, FL 34982-5652 l( Jyv' BY 772-462-1553 St. Lucie Countv APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE I PROJECT INFORMATION ( LD C)I 1. LOCAnomsITEADDRESS: pda" [-�arbottr q,,tdjt. Blvd. PrjB CI*41„FL 3LVIC10 2, PROJECT NAME ; ErAV hour [2gd�Q _ SITE PLAN NAME: SOtAiA., EInIa WE W4kI I 3. PROPERTY TAX -ID M. 4. LEGAL DESCRIPTION (attach extra sheets ifnecessary): ttarboir ICtCy-5z —rlC%T r.— bUt•rt.Vurxt — L-ess NS :�r iaa-0&-I6y8t1650165*3,1L54 5. PLAT BOOK O Q l $ 6. PAGE NO. 1b a b 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): l0 3t60 hc- LOT DIMENSIONS: 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY. L.'kD L,.rCr'#+ Now 6&1GdGte j /Y"C.t- b (g=t _ 11. SETBACKS (ACTUAL) FRONT: 6Jlb- BACK: _ iV RIGHT SIDE: �f�CLEFT SIDE: Z 12, TYPE OF CONSTRUCTION (Check all appropriate boxes) 13. 14. [) NEW CONSTRUCTION KA RESIDENTIAL ,q OTHER (SPECIFY) �! EXPANSION/ADDITION [) INTERIOR RENOVATION COMMERCIAL [) INDUSTRIAL DESCRIPTION OF PROPOSED USE: "e w L `17 4 Sne.t� SQ. FT OF CONSTRUCTION: 15. SF. FT I at FLOOR: 16. VALUE OF CONSTRUCTION: $�� The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County remmes the right to question undlor modify the Indicated valuo of consltuction if it is dcmonstraled that the submitted figures am not consistent with simian types of construction activitic. If the valuo3s $2500 or more, a RECORDED Notice ofCommmoemrnt mustbo submitted with this application. SLCCDV Farm No.: 001-02 UPDATED 612SM r ,OWNERANIFORMATIOW NAME: IUD IW�U CITY: Pot 1 rv\ C 1 hi STATE: r L ZIP: Z') -I I -I. U PHONE(DAYTIME):Q143 316-- 300o Email: r,6CCQ( @ hy4CC. u�'5 IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT PROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BET OW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: PHONE (DAYTIME): STATE: CONTRACTOR INFORMATION ST.ofFLREG.CERT#: Cm- 1ST 2S1 B.USINESSNAME: W\Q.LA G' QUALIFIERS NAME: M k Lill !1'eA G1. ) ZIP: ST. LUCIE COUNTY CERT 9'.�'�� 1 A.n"DVQQ- 2\2 iS • VS kk"'( A— , SU CITY:y '-+x v % u PHONE (DAYTIME): '(5l1 j) 113 ` STATE ZIP: 3 31iLa 9 FAXNO. 511- TO- 3-47 Email: M%V e dD C` AA ARCHIT/ENGINEER 1. 51-+ ies (fee% P.E. ADDRESS: Lk o4 (,w CAS:--Ae Av-e CITY: STATE: (_ ZIP: 3 Y 9 9 y PHONE (DAYTIME): C 21) 2,13 —�' W3 BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER ADDRESS: CITY: STATE: STATE: ZIP: Wo IMPORTANT NOTICE: When a permit is issued „and 'It is not picked up within 60 days: after notification it will be volded' and returned to you by mail. ±. } r nq CERTIFICATION: i""i 121ti This application is hereby made to obtain a>permit to do the work and 'installations as indicated, lea certificate if applicable, for the permitted work. I certify that no work or installation has commenced prior e-i o`a p r work will be performed to meet the standards of ail laws regulating construction in. this jurisdiction. I understand t sept may be requited for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS,, FURNACES, BOILERS, HEATER AND AIR CONDITIONERS, FENCES, ETCo not otherwise included with this building permit application. St. Lucia County makes no representation that its, granting of a permit will authorize the pecinit 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'sAssociation and review,your deed for anyrestrictions which' may apply. The following Building permit applications are exempt from undergoing a full concorrency 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:TOYOURPROPERTY. ANOTICEOF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE FIRST INSPECTION: IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITHYOUR LENDER OF, AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, T1TLE,.AND.INTEREST THAT I$ 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 CONTRACTORSIGNATURE,STATE OF FL.COUNTY. OF ORIDA ? _ - � COUNTY OF —STATE OF A ulA hka dA The foregoing Instrument was acknowledged before me this , dayof �1MAA LVI 2014 by it11C.I�&.eA fQe.widUl who is personally known Vor has produced identification. Signature. of Notary Commission No. iLi- Banded Thor The foregoing. Instrument was acknowledged before methis -1' dayof YV1&kLLA .264 by 1M ( LWA 2A 4b\e-M a" who.s personally known ✓ or has produced IINN It Commission Na BE 170290 Identification. EE 170290 NOTE: TWO (2) SIGNATURES ARE REQUIRED, EACH SIGNATURE MUST BE NOTARIZED, IF APPLYING FOR THIS BUILDING FERMITAS AN OWNERBUILDER, THE OWNER MUST PERSONALLY.APPEAR TO SIGN THIS APPLICATION IN THE OFtTCE LISTED ON THE FRONT OF THIS,APPLICATION.; OWNERBPH,DER AFFIDAVIT WILL BE REQUIRED FORALL OWNER/BUILDERAPPLICANTS. R r: For specific in'istructions see appropriate permit rheeldisL OFFICE USE ONLY SECTION TOWNSHB' ZONING (� LAND USE FLOOD ZONE, FIRM MAP # CONST TYPE OCCUP TYPE WATER SEWER LOT OF RFC Before 111990 LOT OF REC After 1/1990 RANGE LOT CVG % 1ST FIR ELV MAX OCCUP SPRINIQ,ERS LOT SPLIT REQUIRED REPORT CODE Gj 12 1 HABITABLE AREA lOtADON RADON FEE LIBRARY PUBLIC BID P I[PACT IMPACTFEE ACT FEE CORRECTION FEE GENERAL SCHOOL RO CREDIT IMPACT ACT FEE FEE FIRE/EMS DRIVEWAY Y N DRIVEWAY IMPACT REQUIRED FEE FEE SPECIFY / MECHANIC ROOF _ NON -CONFORMING SUBS ELECTRIC GAS LOT OF RECORD REQUIRED _J PLUMBING _ FEES DATE SENT TO ADDRESSING: Y Y+F #• ly�- MAP NO. TAZ NO. MAX HGT !/ OF FIRS STORMWATER LOT SPLIT APPROVED PERMIT PARKS ROACT FEE N ILAW ENF IMPACT FEE ADMINISTRATIVE VARIANCEFEE MISCELLANEOUS FEES REVIEWS I FRONT I ZONING I SUPERVISOR I PLANS I VEGETATION I SEATURTLE I MANGROVE rnrnrran RFVIRW RFVrPW RF.VIF.W REVIEW REVIEW REVIEW 0 I-6 P (L I�nudL -vjAL b(rT $ Goui C 1 OWNER INFORMATION C- 777- 873 - &O'e$ C4'eeec (8 I -rLf NAME: RALeMUM IZIPbIg:Y." """"T { LVLt6/ IdP'SR.P�ourZ J2�Wl�u IDL ADDRESS: 17-9200 N"Ar�5DU-it- R-VAG10- -f7t'L/ o ' CITY: p®(iJA'l_ary STATE: FL7IL4 VA ZIP: TfI-'-(RO PHONE (DAYTIME): Ca 33fc - 3D o o Email: ,r• vet �a , 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 #: BUSINESS NAME: kS dQ-+)Tb -Fd QUALIFIERSNAME: jOV"r (I l--UIL[Z.X. 2 ADDRESS: 13 `Q PN N9`f ^JA t y CITY: ASINPl1koc f' STATE: PHONE (DAYTIME): 5b _ L31T-0010 FAXNO. ST. LUCIE COUNTY CERT #: ARCHITlENGINEEIL• 4M 7 Ri C^JQ hlE-c +'-y - ADDRESS: 404 S LJ &A—EMP eN� CITY: IsrMA1v STATE: FL PHONE (DAYTIME)JM� BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY. STATE: STATE: Email: C.. ZIP: 3`e ` % ZIP: FAn . N .IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification it will be yolded and returned to you by mail. I b(ri 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 roorns, 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 I I LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. lmg A AA� OWNER OR CONTRACTOR SIGNATURE STATE OF FLORM �� L COUNTY OF �J The foregoing instrument was acknowledged before me this I& day of b 20 I Y by LA6 e E G - f who is personally known �Zoor has produced Commission No. A `f STATE; OF ORH)A < L J i (� u iJ COUN OF V 7 l was acknowledged before / me this l o �� ` day of d r 7c uT 20 � who Is personally known _V' or has produced NnIary Public MY Comm Expues Aug 1. 2017 1 - 1• ° r• ^•• 1.1u y; NOTE: TWO (1) SIGNA •R$QUTkEALISOPA MUST BE NOTARIZED, IF APPLYING FOR THIS BUILDING PERMrI' AS A O ' BfJCG WNER MUST PERSONALLY APPEAR -!TO MGN— THIS APPLICATION IN THE OFFICE LISTED ON THEFRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. I 4 t r i 1 I For specific idlstructions see appropriate permit checklist. I as Identification. atur of Notary ftfmissionNo.O�t�a,v7 LAURIE C. SNYDER V Public - State of Florida ire o1 Florida Aug 1.2017 1141047