HomeMy WebLinkAboutCertificate Of Capacity & Zoning Compliance0
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME: Crescent Resources, LLC
ADDRESS: 400 S. Tryon St.
CITY: Charlotte STATE: NC ZIP 28201-1 003
PHONE (DAYTIME): (7 0 4) 3 7 3- R R 4 3
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: same as above
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): ( 1
CONTRACTOR INFORMATION 1a
ST. of FL REG:/CERT #: CGC 033026 ST. LUCIE COUNTY CERT #: I 1
BUSINESS NAME: Keene Construction Co. of Central Fla., Inc.
QUALIFIERS NAME: Gary L. Keene
ADDRESS: 1400 Hope Rd.
CITY: Maitland STATE: FL Zip 32751
PHONE (DAYTIME):
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS
CITY:
FAXNO.(407) 539-3468
Tagliarini Architects
57?0 Into r-bay,.-,RLA _
Tam= a STATE: FL Zip 33611
N/A
MORTGAGE LENDER: N/A
ADDRESS:
CITY:
STATE: ZIP
STATE: ZIP
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.
`.O-
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. 1 understand that
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,
TANKS, 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, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
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 BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE, AND
INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS PERMIT YOU
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN
LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction an mg.
OW ER/ ONTRACTOR SIGNATURE CONY<AcT6kSIGNATURE
STATE OF FL IDA
COUNTY OF L 4kinA
The foregoing instrument was acknowledged
f before me this _2> day of , 20P' n bygam L • t
who is personally known to me or wi4o
has produced kJJ A= as identification.
111111111l111/
Signature of Notary
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Type or Print Name of Notary
Notary Public Title
Commission Number
(seal)
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STATE OF FLORIDA
COUNTY OF _
The foregoing instrument was acknowledged
before me this '? day of �� 20 OZ.. , by
L , who is Pierson y known to me
w o has produced � as identification.
Signature of Notary �`1g1111111l111q//
Type of Print Name of Notary A81200 9�; ;
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Notary Public Title zz. #CC801355 0
ice: Q�
Commission Number
(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 THE FRONT OF THIS APPLICATION.