HomeMy WebLinkAboutSUBMITTED PAPERSSECTION
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NL Y: .
T---TTOWNSHIP RANGE MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
I-T FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT
APPROVED
(before 1190) 1/90) REQUIRED
ADMINST
LIBRARY
PARKS
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLD
HABITABLE
RADON FEE
CODE
IMPACT FEE
AREA r,
SCHOOL
GROSS ROAD
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
IMPACT FEE
IMPACT FEE
DUE-
SCHOOL
CREDIT
Y
N
- - - -
- - - - -_ -
_ -- -
TOTAL
- - __ _ -`:-°°
=
— - _ _ _ ;
`'
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL
Y
N
SPECIFY
TOTAL
of'ALL
PERMITS
FEES
REQUIRED
....... -.v . .:..C-: •Sir-- i:'q' _
REVIEWS
ZONING
ZONING
PLANS
MISC-
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMING
DATE
COMPLETE
INITIALS
f `
l
. FILED. . l ��
DATE R. D
• � PERMI T NUMBE
R:
otU b
PLAN REVIEW FEE: RECEIPT NO.. �_
RECEIPT NO.: CERT. CAP. NO.:
CONCURRENCY FEE: —
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
JL\� COG
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StS'SICI.WR. Lucie County Building and Zoning
2300 Virginia Avenue s ��/
Ft. Pierce, FL 34992-5652e��FO
772-462-1553
04�
y
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: O
2. S/D NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #:
4- LEGAL DESCRIPTION (attach extra sheets if necessary): eecti nn 26, Tnwnshi zn 36s , and
Ranclp 4nE
PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
S/S
PARCEL SIZE: ACRE FT. LOT DIMENSIONS Q
DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: 5ia,ngl a f-am =-r
SETBACKS (ACTUAL) FRONT: \ BACK: \ %\ RIGHT: �� tt LEFT: ��2 i/
20 15� n SIDE SIDE \3�
boxes
)
TION Check all appropriate
12.
TYPE OF CONSTRUCTION
k] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
k ] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
[I INTERIOR RENOVATION
[.r ] INDUSTRIAL
QA
14. Sq. FUCONSTRUCTION: 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: $' _� A.
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 c6nstruction 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: _
ADDRESS: R0 Q A LL1� G„i .t A a n 7
CITY: Dort St IauciP STATE: p'I, ZIP 34957
PHONE (DAYTIME): (172)878 S 51 -4 email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAMEAND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
STATE:
WK
ST. of FL REG./CERT #: C Gr Q 3 5 99 ST. LUCIE COUNTY CERT #: gR9 R
BUSINESS NAME: Lynne Development Corporation --QUALIFIERS-NAME:-- -- -- _ _-_
ADDRESS: f1000 G LT91 , Suite 40
CITY: Pnrt- Ct-T u _i e STATE: FT. ZIP
PHONE (DAYTHVIE) : (7:L2) R 7 8- 5 51 3 FAX NO. (7 7 7) R 7 R_ 7 F S ti email:
ARCHIT/ENGINEER: $rar1 P n F. Rr a r7 a n
ADDRESS: 417 C'oconu Ave -
CITY:' I s t-ua STATE: Fr ZIP 34996
PHONE (DAYTHAE): (_)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
ZIP
0%
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.
CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of ca
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and 1
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate p
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TA
AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, acca
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another
residential use.
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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFOR
RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TIT
AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHEI
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUB]
TO ATTACHMENT.
----------------
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in cc
with all applicable laws regulating construction and zoning.
OWNER%CO�TRACTORSIGNATUI2E' y`4 FTTR
r :f
_ -
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF :Gt 7.13C1e COUNTY OF act - Lljrm}e
The foregoing instrument was acknowledged
before me this -5ti0ay of Mar 21- , 2013, by
known to - or who has produced
as identification.
Signature of Notary
The foregoing instrument was acknowledged
before me this' .th day ofMarrh , 2012by
Mat -thew who i erso a ly
own to me • r who has produced
- - _ as identification.
igiiature of Notary
Susan Magda 4r,.Gan Mamie
Type or Pri Type or Print Name of Notary
SUSANMAGEE taaid;''� SUSANMAG E
MY COMMI 037286 u "= �i, ss
Commissio O '• rJ _+r *- MY COMMISSION # E in No. (Seal)
,NPIRES, ebrua 23, 2015 , oes EXPIRES: February 23, 2015
t�; ' riondodThrd NotMY Public Underwriters ' rp fyd ` Bonded Thru Notary Public Underwriters
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING
THIS BUILING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.
ST. LUCIE COUNTY
BUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
772-462-1553
FILLED LANDS -AFFIDAVIT
1, the undersigned, am the owner of the following described property: 6 �Ci� "kc�
Part of 3414-501-1701-000/9; Section 26, Township 36s & Range 40E
(Tax ID/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Pennit. In accepting
this Final Development Permit, BP Number , I acknowledge that as owner of
the above described property, and in accordance with Section 7.04.01(D), St. Lucie County
Land Development Code, I shall be responsible for assuring adequate drainage so that the
immediate community WILL NOT be adversely affected. I further acknowledge that in
granting this permit for the development of thie Property, et T ucip. Geunty is 9et4ie.rab4,tgtd
nor liable to provide for, or maintain in any form, adequate drainage off my pro. ty which
will not adversely affect the immediate community.
Matthew Lyle Wynne
Property Owner Name zop�ry + - Si nature Date
STATE OF FLOR.IDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS 5th DAY OF March , 20_13
BYMatthew Lyle Wynne WHO IS ERSONALLXKNOWN OMEORWHO HASPRODUCED
AS IDENTIFICATION.
Susan Magee
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY
NOTARY PUBLIC TITLE
SUSAN MAGEE
MY COMMISSION N EE 037286
. grz EXPIRES: February 23, 2015
��; '' Bonded Thru Notary public Underwriters
COMMISSION NUMBER
(S CA L)
03/29/2013 11:24A31 FAX 77220423`•-1, SPANISH—LADES—ONE 0001/0003
J /J/CC-MC-X
13o,3 - o;?,a�:
547 ,6755
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Customer Code: Custonrof Nam*: CustomerJob Number. Order Coda I polo;
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LOAD CUMULATIVE ORnewo MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY gUANTITY
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Cash Check If IAuth Code: Signature of Delver Receiving Cash; Cash Recelved; Total GOD OidgrAmotlnt to Gelloct ;r
'
Without Standby Charges:
Check
Charge
Commentn!
WATERADD� GAL YARDS IN DRUM: `
MAR 2i 9 2013 WHEN ADDED.
'+ SIGNATURE �.
.I
CURB SINE CROSSED AT OWNER'SIAGENT'S REQUEST:
SIGNATURE I
i
p LOAD WAS TESTED BY:
Not]= Our drivers will make every effort to place 'msterlst� wq�re;IUR customer designales, but iho- SPECIAI TERMS: Any wotcr addod Is at motomore own risk. If water le added on Job, concrete strength
Company assumes no responsiblllty for damages Inside curb,or r6loprty line. Customer agrees to the Is np longer guaranteed. WARNING: Product may cause skin andfor eye Irritation, CAUTION: Material
terms of sale and delivery and accepts Concrete ea Is. Dua; to INportenl factors which am out of our may be hazardous Jo- your safety and health, Please refer to the backside or this ticket for Important
control aftsr delivery, this Company will not accept any raeponAllity for the flnished results, No credit for safety handling)nformation, and tot If material sefely data shoots for additional InformsUon.
returned concrete. Buyers excoplions and claims shall be deemed wslved unless made to us to writing AUTHORIZED SIGNATURE:
within one business day *flat the receipt of materials. /l - .
03/29/2013 11:24AM FAX 7722042yg0
SPANI SH-LAI{ES-ONE
0 0002/0003
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t.'.::.4•:Arrive Job, Start Unload- :_:=::Flelah'.Unlotid:*.
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Customer Code: Customer Name; Number; Job Customer b m er: Order Code I Date;
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Ticket Dote; Deilyery Address: Map Pape: Map/Row/Column:
Dellyeiy instructions: :. • •:
�Dispatclier`•.:.
Ticket Number:
.pry:
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Dun On Jap: Slump: Truck Number: Driver Number! Driver Name;
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LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DesGRIPTION UOM UNIT PRICE AMDUN7
QUANTITY QUANTITY QUANTITY
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Check
COmft)ents:
a� Cash Recalvod; Tore. COD order Amount to Collect
f Without Glandby Charges;
y
WATER -ADDED- GAL YARDS IN DRUM;_
WHEN ADDED,
W6 SIGNATURE
CURB LINE CROSSED A'I' OVV NE-R'S/AGEN-I'S REt]L l--S I
— ' ---- SIGNATURE
CI LOAD WAS TESTED BY:
Nolica: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERMS: Anywator added is at customers own rlek. If water Is addeq on fob, congrote strength
Compony asaumes no responaiblllty for damages Inside curb or property line, Customer agrees to the is no longer guarantoed, WARNING; Product may cause skin and/or eye irrilallon, CAUTION: Material
terms of Yale and delivery and accepts concrete as Is. Dus to Important factors which are out of our may be hazardous to your safety and health, hleasa refer to the backside of this ticket for Important
control after delivery, this Company will not accept ony to ponsiblllty for the finished results, No credit for safety handlingg.Information, and to the material aofory data aheets for additional information,
returned concrete. Buyers exceptions and claims shall bo deemed waived unless made to us In writing AUTHORI36C SIGNATURE:
withrn one business day after the receipt of material;, n
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