HomeMy WebLinkAboutSUBMITTED PAPERSDATE FILED:
PLAN REVIEW FEE: RECEIPTNO.: PERMIT NUMBER;
CONCURRENCY FEE: RECEIPTNO.: CERT. CAP. NO.'. -
ALL INFO MUST BE COMPLETE & FILLED W TO BE ACCEPTED
J
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
I DWG & CODE REGUILAUONS D"ION
'COUN Y BUM 2300 Virginia Avenue
F L 0 R I D A FL Pierce, FL 34992-5652 SCA
.772442-1553 �/Veo
Jcie
APPLICATION for BUILDING PERMIT
CERTIFICATE of i��i��CITY/ Z O-NING COMPLIANCE
PROJECT INFORMATION
I LOCATIONISITE ADDRESS: 7
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID'#: 000//
4. LEGAL,DESCRIPTION (attach extra.sheets ifnecessary):
5. PLAT BOOK 6. PAGE NO. 7. - BLOCK NO. 8.. LOT NO.
UA It
9. PARCEL SUE (ACRES/SQ FT.): LOTDRAENS,IONS:
10. COWLETE )?ESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTM
de Y-, .97
�9 ' * 4,30W 64 A',za V, P'L
300o ?51- f /- gy, !L� I
� (�p - , i AdAl2-
Il. 11qFTBffrKS (ACTUAL) F . RONT: — BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION EXPANSION/ADDITION INTIERIOR RENOVATION
Vd RESIDENTIAL COMVIERCIAL INDUSTRIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION. 15. SF. FT Ist FLOOK-
16. VALUE OF CONSTRUCTION: $ 5"q 3 ar—', .
The value of 6onstruction is used to determine the amount of permit fbes to be assessed. St Lucie County reserves the rigbt to question andfor modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500.or moM a
RECORDED Notice ofCommencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDAUD 6/25/09
OWNER INFORMATION
NAW: jo 60
ADDRESS:
CITY: F14114 STATE: zip:
PHONE(DAYTlME),',.C.?J?2� Email:
Aq
IF THE FEE SIMOU TITLEHOLDER (PROPERTY OWNER) IS DIFFEREN T FROM THE OWNER LISTED ABOVE, PLEASE
� -, �5 �, '. 11
FILL IN NAME�A, i kSS BELOW.
Q ADV
FEE SIMPLE TITLEHOLDER'
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTROE): (___)
CONTRACTOR -INFORMATION
ST. of FL REG.CERT 0: ST. LUCIE COUNTY CERT 2- �(76
BUSINESS NAME:
QUALIFIERS NAME:. too-/
ADDRESS:
CITY: fllul_� STATE: ZIP:
PHONE (DAYTIME): 0( e,7 7 FAx No. 7 Email:
ARCfflT/ENG1NEER_
ADDRESS:
CITY:
PHONE (DAYTHWE): C__)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER.
ADDRESS:
CITY:
STATE:
STATE:
STATE:
rA 10
r7112
ZIP:
IMPORTANT NOTTCE: When a permit. is issued and it is not picked up within 60 days after notification
it wiff be voided and returned to you by maiL
CERTMCATION:
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 co . venants 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, sips, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWWER: YOURFAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COM[MENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE TBE
FIRST INSPECTTON. 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 INUREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF TBE CONSTRUCTION LIEN LAW NOTICE TO
TBE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FL0J"A 1, 1
COUNTY OF A_
The foregoing instrument was acknowledged before
me this Q:�Dday of 20_j_D,
Z_oc- ,
by � M t � � 61mi
. 175_�
whz� �rDlown or has produced
ANGELA M. HUFF
Commission No. MY COMNI&W) EE 083530
EXPIRES: April 12,2015
Bonded Thru Notary Public Undenwiters
0 1 M-04 -1 7 =��W
STATE OF FL04MA
COUNTY OF �:= L�4 CA
The foregoing instrument was acknowledged before
me this Q�day of , 5(:)k A'\- 20_1a
b, k�
whj!��own or has produced
as identification.
/WA&_ I I
Signature of(!�Ita - - - - ANGELA M. HUFF
.."1401"",
Commission No. y EE OMO
MEXIPI 1"ll 12, 2015*
Bonded Tbru Notary Public Underwriters
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OMCE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFTEI)AVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
F[O:FF�ICIE USE 0NU--- BP #:
SECnON
TOWNSHIP
RANGE
MAPNO.
ZONING
LANDUSE
%A
LOTCVG%
TAZNO.
FLOOD ZONE
IBM MAP
ISTFLRELV
MAXHGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER.
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Balro 111990
After 111990
REQUIRED
APPROVED
REPORT
HABITABLE
RADoN
PERMIT
CODE
AREA
(RADO
FEE
FEE
LIBRARY
PUBLIC BID
PUBIC BID
PARKS
BRACT
IMPACT FEE
IMPACT
BRACT
FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
y
N
LAWENF
BRACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE)EMS,
DRIVEWAY
Y
N
DRIVEWAY
ADAIR41STRATTVE
BRACT
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
SEATURTIE
MANGROVE
COUNTER.
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE. -
RECEIVED
DATE i
INITIALS
Building Permit# "
Planning & Development Services Department
Building & Regulations Division
Product Review Affidavit
Owners Name
Applicant:
Product
Opening Design
Pressures
Product Rated
Design Pressure
Manufacturer
Model Number
Product Approval
Number
Glass
Tvve
Method of Attachment
Windows
Mullions
Vixed Glass
Block -Glass
Skyll ghts
Silding.Glass Doors
swing Type Doors
French Doors
Garage Doors
Hurricane Protection
Roof Ventilation
Roofing Material
I have reviewed the above components or cladding and I have approved their use in this structure. These products provide adequate resistance to the
wind 102ds and forces specified by current code provisions.
Name:
Design Prof.
Cert. No.
Signature:
Date:
seal
OMM USE'0;.NLY-
DATEFILED:
PLAN REVIEW ME: RECEIPTNO.: PERMITNUMMER:1XI-6165
CONCURRENCY FEE: RECEIPTNO.: CERT. CAP. NO.:
I .
2.
3.
4.
5.
9.
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS D"ION
2300 Virgirdla Avenue
Ft Pierce, FL 34992-5652
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICAT'E of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS: :Z q A
PROJECT NAME- SITE PLAN NAAE:
PROPERTY TAX ID #: I'S 0 1 0 q 21R, Is - 0 901Z I
LEGAL.DESCRIPTION (attach extra sheets if necessary):
PLAT BOOK 6. PAGE NO.
PARCEL SIZE (ACRES/SQ FT.):
7. BLOCK NO.
LAO4 q
LOTDIMENSIONS:
8. LOT NO.
T%
10. COWLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTlVITY:-&CKi)DVr-
,r,2,9'
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION
RESIDENTIAL COMNERCIAL INDUSTRIAL
OTHER(SPECIFY)
13. DESCRIPTION OF PROPOSED USE: A- L?
14.
16.
SQ. FT OF CONSTRUCTION: q
'i 6 15. SF. FT Ist FLOOR. -
VALUE OF CONSTRUCTION: $—,.,23 o � - L9,9
The value of construction is used to determine the amount of permit fm to be assessed. St Lucie County reserves the rigirt to question andlor modify the indicated
value of construction if it is demonstrated dw the submitted figures arenot consistent with similar types of construction activides. If the value is $2500 or more, a
RECORDED Notice ofCommencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
N.
OWNER INFORMATION
NAME: aL LA mz�o
ADDRESS: -7 q1D k A-y
CITY: STATE: zip:
PHONE (DAYTRvIE): (�r& Q(vS - (o Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FELL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: ST. LUCIE COUNTY CERT
BUSINESS NAME: rl- 00 A16fr- 4 C- 6 �e PV, tv C-'
V"-1
QUALIFIERS NAME:. --/--
ADDRESS: P0 S 9 Y- / 2�O Z 0
CITY: STATE: ;7 t Zip: 72
PHONE (DAYTIME): 77- v/ —/q 1 -5' FAX NO. Email:
ARCHIT/ENGINEER-- 4)
ADDRESS:
CITY:
PHONE (DAYTMM):
BONDING COMPANY: tkiL
ADDRESS.,
STATE: 21P;
CITY: STATE- ZIP:
MORTGAGE LENDER. tY
ADDRESS:
CITY: STATE: ZIP:
BIPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it wiR be voided and returned to you by mal
OFFICE USE ONLY
SECTION
TOWNS"
3LI
RANGE
39AI
MAPNO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
ISTFLRELV
MAXHGT
CONST TYPE
OCCUP TYPE
MAXOCCUP
OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
(ILADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BID
IMPACT FEE
CORRECTION
PUBleBLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
BRACT
FEE
CREDIT
y
N
LAW ENF
IMPACT
FEE
FIRE/EMS
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
DATE SENT TO ADDRESSING: I I
REVIEWS
FRONT
'COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
.INITIALS
16
CERTMCATION:
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 Associa ' tioin rules, bylaws.or any co . venants that may restrict or prohibit such
structure. Please consult with ur Aomeowner's Association and review your deed fqr any restrictions which may apply.
yo
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 TBE
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 TBE CONSTRUCTIONLIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. '
Je
OR CONTRAtTOR W UWME
STATE OF FLORIDA
COUNTYOF_ SA
The foregoing instrument was acknowledged before
me this Ofj�nuk`LS420
byJ80-M P6dLJ_Yv\b0
who is p�rsonally known or has produced
CONTRACTOR SIGNATURE
STATE OF FLO
COUNTYOF
The foregoing instrun
me this _Z�Lday of
by
who is personally known
s identification.
Signature of Notary Sigi
,,I,p,Ry P" 1,
P, 11 SET L TSKY
e NOtarY Pub Co'
UD q (to M '0
Commission No.. A 0 c - S ate ot Flori'd'a
My COmm. E ireS Feb 9, 2014
F F,�C, COmmission # DD 960096
Bondau TWO�9h Nati n2l Wary Assn.
if Notary
was acknowledged before
U�Vt)24 q .20
)hl*
�_Zor has produced
identification.
7777__��_
J)kW%MJL0%E B52587
C00SS1'3"')' OA3
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EArWS?GWTftE 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.
OWNER BUILDER AFTIDAVIT WILL BE REQUIRED FOR ALL OWNERIBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
w
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,
C>poll
(Parcel Id#/Legal description/Address)
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 fiirther acknowledge that in granting Us 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 �roperty which will not adversely affect the immediate
community.
0 kri 0 &P�
prty Owner Name (Please Print)
Owner
STATE OF FLORIDA, COUNTY OF fr�-
2-�113 - --
Date
ACKNOWLEDGED BEFORE ME THIS F�— DAY OF::�"�a�., 201,
BY 3�1---) PaILLM—Lb WHO IS PERSONALLY KNOWN TO NE OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY P�BtIC TYPE OR PRINT NC
W9 CONMSSION NUMBER
Pya BETTY SLUTSKY
Notary Public - State of Florida
My Comm. Expires Feb 9. 2014
Commission # DI) 960096
SLCPDSD Revised 09/24/20 10 Bonded Thiough Natioria, Nula,y Assn.
E-
conTinenTr 0
HEIDELBERGICEMENTGroup
Continental Florida Materials Inc. 1705243
13450 W. Sunrise Blvd., Suite 430 �-aot-olo
Perm
Sunrise, FL 33323
Tel: (954) 858-0786 CAUTIONH Freshly mixed cement, mortar,
UNLOADING Drivers are prohibited
concrete or grout may cause skin injury. Avoid
from delivering concrete except under the
contact with eyes where possible and wash
truck's own power, and where she conditions
exposed skin areas promptly with water. If any
permit the safe and proper operation of his
cement mixtures get into eyes, rinse immediately
equipment. Drivers are not permitted to
and repeatedly with water and get prompt medical
add water to the mix nor to go beyond the
treatment. Sawing, or grinding of concrete
curb line, except upon the authorization of
masonry units may result in the release of dust
the Purchaser/Purchaser's Agent and his
particles which, without the use of proper eye or
acceptance of risk for any loss or'damage.
respiratory protection, could cause eye or nose
I acknowledge that / have received and
irritation The Material Safet Data Sheets for
a led the materials listed on this ficket
the products sold by Continental Florida If understand and agree to the terms on
Curb line crossed at Purchaser/Purchaser's Agent request. Initials of Purchaser/Purchaser's Materials Inc. are available upon request. both the front and back of this fickeL
Agent TOTAL
WATER
Initials of Purchaser/Purchaser's Agent acknowledging addition of water at Purchaser/Purchaser's YARDS ON TRUCK/ GALS OF WATER ADDED ADDED
Agent request. 10 9 1 8 1 7 1 6 [� 5 1 4.1 3",,l 2 1 1 1
ARRIVALTIME START POUR TIME FINISH POUR TIME LEAVE JOB TIME
PURCHASER/
PURCHASER'S AGENT
YPURCHASER S AGENT P.O. NUMBER/ ORDERED BY ZONE JOB NUMBER
S' 21E.1,121 I
SOLD -TO ' DELIVER TO
3011TH FIL F,6.PViC[-'S MC SA-t-Jfi4-,0EA
-DA -TICKET
Concrete Disposal: yds
'QUIANTITY
QUANTITY
QUANTITY
PRODUCT
PRODUCT DESCRIPTION,
UNIT OF UNIT EXTENDED
THIS LOAD
ORDERED
DELIVERED'
CODE
MEASURE PRICE PRICE
9. FJ 1.)
61
4C
"000 F'S I Q. 28 DAY-5
REGUIA-N�
vy
1�' FIX
i2- �I; i 'i Lt ii4 D
1;5 1 —6 y I
cvt
�'-1099
7— I�N V7f"F-.F.,-
Truck #
Plant #
Slump
Due at Job
Use of Concrete
SUBTOTAL
Calcium Air Entrain Super Plas. Drivers Name
tii,�Ifh, TAX
L1 CONCRETE TESTED TOTAL
Delivery Instructions U--tinuou fGH 772 201 1 4tj�j
0-;_1 1-4- . M;- C[1,qTC)MFR
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