HomeMy WebLinkAboutCertificate Capacity, Zoning ComplianceBP#: 0510- 0159
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SECTION:
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
S'
LAND USE:.
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
'PUBLIC BLDG
HABITABALE
RADON FEE
CODE
IMPACT FEE
AREA
.(RADON)
(�
Y
N
ROAD
1 1 \�t
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
Y
N
SCHOOL
CREDIT
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE.,
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
IN:,
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
_
FEES
REQ'D
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE
4q®�
�/ �/
, . • -
INITIALS
�I G
OFFIGEIUSEOILYY
DATE FILED: O ' lY
PLAN REVIEW FEE: RECEIPT NO.: 2105$ PERMIT NUMBER: Iu l0 61 fJ q
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE CO F COMPLETE 8� FILLED IN TO BE ACCEPTED
Cray ST. LUCIE COUNTY PUBLIC WORKS
1 BUILDING & ZONING DEPARTMENT
� '20R10Q' FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: _ 7 �f ��� le / /Q
2. S/D NAME: / -eln SITE PLAN NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
z 2
5. PLAT, 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LAG - LOT DIMENSIONS
13.
DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY. ���
5$
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Life% G�7
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SET ACK S ACTU L FRONT: �
BACK: RI
SIDE SIDE: -
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TYPE OF CONSTRUCTION (Check all appropriate boxes)
[q1 NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY) ;
DESCRIPTION OF PROPOSED
14. Sq. Ft./CONSTRUCTION:
16. VALUE OF CONSTRUCTION: $ az2Ud • GI?� :.
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
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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 ccitsistent with similar types of construction 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:
CITY:
PHONE (DAYTIME):
IF THE FEE SIMPLE
BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: _
P
PHONE (DAYTIME): _
STATE: /<-
(77A
(PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED
STATE:
ZIP _
PLEASE FILL IN NAME AND ADDRESS
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: A �C�C G ���J� / ST. LUCIE COUNTY CERT #: ! �w
BUSINESS NAME: �/T/V/ U�j�(` /✓'(B! /��C� ZL
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
ZIP
Z40 r� p� L STATE: �/ ZIP
(/ r� 2.2) �`� (o �' �4 FAX NO. 6—
ARCHITIENGINEER: JQ LG� (�J L!� r2
ADDRESS:
CITY: j ,
I�
• STATE: ZIP
PHONE (DAYTIME): -M -7[s/- (150.1
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
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
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, 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 AFFIDAW:
I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zo ' g.
R SIGNATURE CORTFOblIbR SIGNATURE
STATE OF FLIr a
COUNTY OF STATE OF FLORIDA
_L,�- COUNTY OF CLs2
The foregoing instrument was acknowledged The foregoing instrument was acknowledged
before me this 4��o
20 �1� by before e is �3 day of X20�, by�l/� who i me or who who is personally known to me
has produced /a"s ide tification. or who has oducedAW�A�as identification.
Signature -t-ry i nature of IIIII(fgoi�,
1 INLEy lip.
� � ��Fcv�% •••IONF /lJ�.
' •••( 8, 20p�'O9 ' o
Type or Print Name of Notary Type of PriiR Nape NotarjV'*
Notary Public Title Notary Ftic #p�aso7 �.Q`
I
� pondedlYa���
!I N HAFNER D� B COfTI@
°`P �8�" IIIIIIIN Notary Public - State of Florida
(seal a eNNCommissionE�gxresOct2,2008 (seal)
Commission # DD330157
1r' FF��ndedbyNatlonalNotaryAssn.
I NOTE: 0 2 S G A U R U ED. 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.