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HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE:.USE bNI;Y: DATE FILED: q q PLAN REVIEW FEE: RECEIPT NO.: CONCURRENCY FEE: RECEIPT NO.: 1. 2. 3. 4. 5. PERMIT NUMBER: 1 0"q - — " CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue SCANNED Ft. Pierce, FL 34982-5652 BY 772-462-1553 St, LuCis C®U11fy APPLICATION for BUILDING PERMIT CERTIFICATE ®f CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION LOCATION/SITE ADDRESS: �j .Q Ape e a-Cn EA O , PROJECT NAME: SITE PLAN NAME: PROPERTY TAX ID #: �- C © ® 6 Z- LEGAL DESCRIPTION (attach extra sheets ifneeessary): S 0. LIC�X-A-Ia• C At L �L Lio 61,g ge) 14f s [tea®e- 2(641° PLAT BOOK E 3 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: 10. LETE DESCRIPTIO OF CONSTRUCTION PROJECT OA WORK ACTIVITY; 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE:' LEFT SIDE: 12, TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [L4--RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: h z v 14. SQ. FT OF CONSTRUCTION: 2. 6 C 15. SF, FT 1 st FLOOR: 16.' VALUE OF CONSTRUCTION: $ 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 arc not consistent with similar types of constriction activities. Irthe valucls $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 r OWNER ONFORMATRON 190 NAME: J D k /t- - �0 ADDRESS: (-900 CITY: �.5�- p STATE: Tz— Zip: / J PHONE (DAYTIME): ' (17,-)- 6 ,C Email: �L-z-gr— IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: _- STATE: ZIP: PHONE (DAYTIME): U ST. of FL REG. CERT #: BUSINESS NAME: r� QUALIFIERS NAME. O•>2.. C erf'P, . SA ors 1�l CERT #: ';�-KK 8 O CITY O/- r Si • L- C.l- 6 f STATE: F C_ ZIP: �- PH E (DAYTIME):77 SQC$� FAXNOs--? Email: / ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): (_) BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: STATE: ZIP: ZIP: ZIP: IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days alter notification it will be voided and returned to you -by mail. i i UCY OFFICE USE ONLY SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV M IA CONST TYPE OCCUP TYPE MAX OCICCL11111# OF FLRS WATER SEWER SPRINKLERS STORM WATER LOT OF REC OT OF REC LOT SPLIT LOT SPLIT Before I/1990 After 1/1990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE % % I v AREA FEE FEE (RADON) LIBRARY PUBLIC BLD PUBIC BLD PARKS IMPACT IMPACT FEE IMPACT IMPACT FEE CORRECTION FEE FEE GENERAL SCHOOL ROAD CREDIT Y LN 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 MISCELLANEOUS SUBS ELECTRIC GAS LOT OF RECORD FEES REQUIRED PLUMBING FEES DATE SENT TO ADDRESSING: REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED (� DATE COMPLETED 1NITIALS 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- 'resideitial 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 C TRA R SIGNATURE Q �123� STATE OF FLORIDA o s COUNTY OF R3 " M a F,,mv m= � The foregoing instrumenF nowledged``befor - me this day of20 (� by c�i gn �� who is personal know or has produced IT05 Z 70 !.1 = i 9c" m COm �Zi s identification. R omM m O Signature of Not y Commission No. (Seal) CONTRAC STATE OF FLORID COUNTY OF The foregoing instrument was acknowledged before Me this _day of 20�.� by who is personally own or has produced as identification. AA nature of a Commission No. (Seal) NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH 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 T1HE FRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. ' For specific Mptr coons see appropriate pe>rmft Peemlflst. s i PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772)462-1553 FILLED LANDS AFFIDAVIT I, the undersigned, am the owner of the following described property, J. 4'' S 7Q Z -- D i 74f - 4� 6� �� o L. o 1 S (Parcel Id#/Lega description/Address) god, f����R for which I have applied to St. Lucie County for a -VInal Development Permit. 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 this property, St. Lucie County is neither obliged nor liable to provide for, or maintain in any form, adequate drainage off my property which will not adversely affect the immediate community. Property Owner Name (Please Print) P erty Owner Signature Date STATE OF FLORIDA, COUNTY O.F:VVzl cic�� ACKNOWLEDGED BEFORE ME THIS (O DAY OF 202=2— BY C a/� srrkf. Z.� WHO IS PERSONALL KNO WN TO ME OR WHO HAS PRODUCED SIGNATURE OF NOTARY PUBLIC FIE / dI 0 G COMMISSION NUMBER SLCPDSD Revised 08/24/2010 AS IDENTIFICATION. TYPE OR PRINT NOTARY �SPpY HUei ELLEN L. BOULETTE Notary Public State of Florida •_ My Comm. Expires Sep 25, 2015 Commission # EE 101180 Bonded Through National Notary Assn. JVLESM 1142 Water Tower Road Lake Park FL 33403 . Administration Office:1-877-484-9994 / Fax:,561-848-1501 South East Florida Division Dispatch: 561-844.9994 / Central Florida Division Dispatch:407-339-5311 Concrete Tested ❑ Yes D No LOT # Water Added at Customer's Cylinders Taken ❑ Yes QNo Request • s .� gals. to full load Comments gals: to 2/31oad gals. to 1/3 load Customer's Rep - Water Added r D NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN' AND EYES ADDITIONAL `WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with CONCRETE WILL REDUCE ITS STRENGTH' SURFACE. DISCOLORATION skin and wash exposed skin areas promptly with water. If any cement powder or mixture gets into eyes, rinse immediately and repeatedly with water and get prompt AND DURABILITY. ANY WATER' ADDED 1S BATCH TIME' medical attention. Keep children away from cement powder and all freshly mixed ATCUSTOMER'S OWN RISK. cement products. egin ash To Plant 7TICKET# ORDER # TRUCK 11 LOAD SIZE Mix SLUMP DATE CUSTOMER # SOLDTO P.O. # PROJECT# DELIVERY ADDRESS ZONE# USE DRIVER ' , - ,'I t tINSTRUCTIONS' TIME' DUE CUMULATIVE ORDERED PRODUCT CODE PRODUCT DESCRIPTION I.I.Omm. I • ! ! QUANTITY i `e x Si SIGNATURE OR RECEIPT - CONCRETE AND ACKNOWLEDGEMENT OF HAZARD WARNING - asc meyer Concrete Company will not assume liability for any property damage or any SUB-YOTAL. equipment damage for any deliveries beyond the curb line. ,,.r — m- TAX lx .w� �, D "±� AUTHORIZED BY SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE: TOTAL