HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY: I�
DATE FILED: _ PERMiT NUMBER
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DfuM, I'MD
2300 Virginia Avenue s y
Ft. Pierce,762-35532-5652 St. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRE S: / r S. I I , "
2. PROJECT NAME: L°� SITE PLAN NAME:
3. PROPERTY TAX ID #-- 7
4. LEGAL DESCRIPTION (attach extra sheets if necessary)- ffja� /0
5. PLAT BOOK_ 6. PAGENO. 7. BLOCKNO_ 8. LOT NO. 2— r ✓�
9, PARCEL SIZE (ACRES/SQ FT41--�LOT mENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT:_ BACK: _
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
4,[1 NEW CONSTRUCTION [ ] EXPANSIONIADDITION
[ ] RESIDENTIAL C I COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OEPROPOSED USE: 12V ��r�1 / 0 5
SIDE:l LEFT SIDE:
[ ] INTERIOR RENOVATION
C ] INDUSTRIAL
14. SQ_ FT OF CONSTRUCTION: % �_�C� _ _ 15. SF. FT 1st FLOOR:
16_ VALUE OF CONSTRUCTION: $ 2go®
The value of construction is used to determine the amount ofpetmit fees to be assessed- St Lucie County reserves the right to question and/or modify the indicated
value of construction if it is dcmoustratod that the submitted fisures am not consistent with similar types of construction activities_ If the value is $2500 or more, a
RECORDED Notice of Commencement crust be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6125109
OWNER INFORMATION
NAME: r— c
ADDRESS: Elam// Z t
CITY:�rclil
PHONE (DAYTiN1E): % C
IF THE FEE SIN[PLE TITLEHOLDER (PROPERTY
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER -
ADDRESS:
CITY:
PHONE (DAYTIME): ( )
CONTRACTOR INFORMATION
STATE:
ST. of FL REG.CERT #:
BUSINESS NAME: 1116el4h'
QUALIFIERS NAIVE:
ADDRESS:
CITY: STATE:
PHONE (DAYTHVIE): ( ) FAX NO.
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): (_,
BONDING COMPANY:
ADDRESS:
CITY:
STATE:
STATE:
MORTGAGE LENDER:
ADDRESS:
CITY: STATE:
AI '
ST. LUCIE COUNTY CERT #: ` /i C �✓
Email:
ZIP:
I 1•
FVJ
ZIP:
WORTANT NOTICE: When a permit is issued and it is not picked up within 60 dates_ 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 capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced por 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"pemut 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 PE,RSON WHOSE PROPERTY Is SUBJECT TO ATTACHINIENT.
F.
Y
&R40R CONTRACTOR SIGNATURE CONTRACTOR SIGNA
r STATE OF FLO A 1
STATE OF FL A
COUNTY OF /' C� COUNTY OF
The foregoing instrument
was acknowledged before
me this � day of 20 1 J
by
whi4%�:
or has produced
The foregoing instnunentt was acknowledged before
me this day of �Jl_ Q - , 2L7�L,
by 21-
wh is personall known or has prod
as men
Signature o 1 ANGELA M. HUFF _
MY COMMON # Y�; 0
commission I Bonded Thru Notary April
1 Underwriters
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
Tfns Bui LDING PERMIT As AN oWNER/SUILDER, 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 OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY
SECTION
TOWNSHIP
ZONING
LAND USE
FLOOD ZONE
FIRM MAP #
CONST TYPE
OCCUP TYPE
WATER
SEWER
LOT OF REC
LOT OF REC
Before 1/1990
After 1/1990
i
LOT CVG %
IsrFILL-ELV
MAX OCCUP
SPRINKLERS
LOT SPLIT
REQUIRED
REPORT
HABITABLE
A ON
CODE
AREA
(RADO
LIBRARY
PUBLIC BID
IMPACT
IMPACT
IMPACT FEE
FEE
CORRECTION
FEE
GENERAL
SCHOOL
OAD
CREDIT
IMPACT
IMPACT
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
IMPACT
REQUIRED
FEE
FEE
SPECIFY
MECHANIC
ROOF
NON -CONFORMING
SUBS
ELECTRIC
LOT OF RECORD
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:
�•
• t I
Irons,.
nr R:
MAP NO.
TAZ NO_
MAX HGT
# OF FLRS
STORMWATER
LOT SPLIT
APPROVED
PERMIT
FEE
PARRS
IMPACT
FEE
Y N LAW ENF
_ IMPACT
FEE
ADMINISTRATIVE
VARIANCE FEE
MJSCELLANEOUS
FEES
SUPERVISOR;W17/
Zw
S VEGETATION SEA TURTLE MANGROVE
REVIEW EREVIEW REVIEW
`�
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
Id#/Legal descriptiod/Addrem) 601/�- c� o�Ao 1 q D b
D/ 02 6 V -000 �
for which I have applied to St. Lucie County for a Final 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 neither obliged nor liable to provide for, or maintain in any form,
is
adequate drainage off my property which will not adversely affect the immediate
community.
Owner
Owner Signature
��/L3/615
Date
STATE OF FLORMA, COUNTY OF ,57 / ve% .
ACKN EDGE) FORE ME THIS _ \ DAY OF
BY ��1 01- � 20 � .�
f, WHO IS PERSONALLY KNOWN TOME OR WHO HAS
PRODUCED �� �/�J/� Oil
S NATU 17 OF NOTARY PUBLIC
6 E T W COMMISSION NUMBER
SLCPDSD Revised 08242010
AS IDENTIFICATION.
TYPE OR PRINT NOTARY
DIANE M. FRANZE
r9"'t
Notary Public -State of Florida•My Comm. Expires Aug 26. 2015=Commission # EE 114050�....�Bonded Through National Notary Assn.
CC RETE DISPATCHERS-
MI.�-m„,..-DADE: 305 264-7101 I
SUPERMIX DEERFIELD: (954) 480-9333 3
BLOCK PLANT: (305) 805=3226
i4 `The On Time Concrete Company"O, WWW-SUPERMIX.COM
-� CENTRAL CONCRETE SUPERMIX, INC.'
LARGEST INDEPENDENT READY -.MIX
CONCRETE PRODUCER IN FLORIDA CUSTOMER NO. DELIVERY TICKET DATE
MAIN OFFICE: 4300 S.W. 74th Ave. - Miami, FL 33155
PHONE: (305) 262-3250 - FAX: (305) 267-0698
SERVING M_ IAMI-DADE, BROWARD, PALM BEACH, MARTIN & ST. LUCI8• COUNTIES
SOLD TO DELIVERY ADDRESS
F."ER _38 LOT J. I(-'6_.'4_4
QUANTITY
DESCRIPTION
PRICE
UNIT
EXTENSION
�' a �'.l (/Y
t
Jl11 : ..:el,+it•i !'l 1��-•.'l :� II _��„
� id
'
MINUTES ALLOWABLE TIME' PER MINUTE
EXTRA UNLOADING TIME CHARGE y
_
i = X $1.00 =
,
"6 MINUTES PER CU. YD. ALLOWED SHORT LOAD CHARGE y
SLUMP
� ' ` - -'�`
THIS DELIVERY TOTAL CU. YDS.
AMOUNT
OF YOUR ORDER -FOR CU.;YDS.
TAX
CUSTOMER OR HIS AGENT ASSumES FULL RESPONSIBILITY FOR STRENGTH AND/OR
PERFORMANCE OF ANY--CrACRETE PLACED ABOVE DESIGN SLUMP OR WHEN
• ♦'
WATER IS ADDED. _ -WATER ADDED ❑ YES ❑ NO I GLS.
IME-ARRIVED ON JOB STARTED UNLOADING FINISHED UNLOADING T LEAVING THIS JOB TOTAL TIME
SUBJECT TO THE TERMS, CONDITIONS AND "CAUTION" WARNING LISTED ON BOTH THE
FRONT AND BACK OF'THIS TICK�j T. .
a
TRUCK DRIVER I acknowledge that I have'regelved anf� accepted the✓materials listed.on this ticket. I
understand and agree,to�t . /erms o/n fh the fro`oht.and back of this ticket.
i
fr,`S, ; 7 :'d-?ir.`� ??'1 i�ll.:d~-I`!T RECEIVED BY: X ' s// l / l
CONTROL
..14-�09165 4 T
20 LOADINGIPOINTS AT 15 LOCATIONS TO SERVE YOU�B TTER
MIAMI - DOWNTOWN MIAMI - A'RPORT - OPA LOCKA - MEDLEY - PERRINE - P,EMBROKE PINES - DEERFIELD f
BOCA RATON - RIVIERA BEACH - STUART - W. BROWARD - FT. PIERCE - E. BROWARD - DELRAY(' r
PRODUCERS AND SUPPLIERS OF QUALITY READY MDCED CONCRETE AND CONCRETE BLOCK NRMU. :
DELIVERY COPYna,
C L3` (.`)NH FRESHLY MIXED CEMENT, MORTAR, CONCRETE OR
"ROUT CAUSE SKIN INJURY AVOID CONTACT WITH EYES WHERE
POSSII�. s AND WASH EXPOSED SKIN AREAS PROMPTLY WITH WATER.
IF ANY k-':'�7�-,,€EN �9 MIXTURES CET INTO EYES, RINSE IMMEDIATELY AND
REPEATEi-�-- `.' WITH '"WATER AND GET PROMPT MEDICAL TREATNIFAT.
SAWING, OR irk--"INIDINC OF CONCRETE MASONRY UNITS MAY R 11�'-JLT
IN THE RELEASE:1, , F DUST PARTICLES WHICH, WITHOUT T!,' IE �.:.� �'�. OF
PROPER EYE OR . Eti " - I ATORY PROTECTION, COU 1I nD ,1 : ` ►E EYE OR
NOSE IRRITATION. VHS' �.,�,,�TERIAL S_AF�ETY DA�Cv_��+ ,:T��m�,�:ETS FOR THE
PRODUCTS SOLD BY C��I'�JTRAL CONCRE-ptlil 66PERMIX, INC. ARE
AVAILABLE UPON REQUE-JT
UNLOAOI - DRIVES S ARE'PROHIBITED FROM DELIVERING
COI ECG F "" 'EPT UNDER THE TRUCKS OWN POWER, AND WHERE
: -.:'NS PERMITTHE SAFE AND PROPER OPERATION OF HIS
;RU4: L\�fr D_RT'Nf_ : _S_A_ ICE NOT�PERMITTED TO ADD WATER_j u_Tj�O-T�H.gE
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iML r IESPONSIBILITY FOR
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'•.: '-t - n AIMS MUST DE MADE
IF IT BECOMES NECESSARY TO tING jA:El
AMOUNTS DUE C-N THIS INVOICE, P! I-P HAr E
FOR REASONABLE ATTORNEYS Fr.� ,•o AND S(
BY VEN yOR IN SECURING COLLF r. `I ONS. IN
AT 1 1/2% PER MONTH ON OUT,---.TiIINDING
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ST. LUCIE COUNTY
BUILDING DIVISION
REVIEWED
FOR CO
REVIEWED BY
DATE,�— f
P-LANfS AND P R M I T
MUST BE KEPT ON JOB OR
NO INSPECTION WILL BE MADE
o to/ L4
THESE PLANS AND AU, PROPOSED WORK
ARE SUBJECT TO ANY CORRECTIONS
REQUIRED BY FIELD INSECTORS TMT
/M+AY gBE NEC�yE,�BAEA RY IN O/y � R TO Cc