HomeMy WebLinkAboutCertificate Capacity, Zoning ComplianceSECTION.
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PERMIT
VARIANCE
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IMPACT FEE
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REPORT
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HABITABLE
RADON FEE
CODE
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IMPACT FEE
AREA
(RADON)
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TOTAL ROAD
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REVIEWS ZONING ZONING PLANS iv
REVIEWED BY EXAMING
DATE 51 J31 � ) ' 71 Fr
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TOTAL Ste.
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MISC FEES
TOTAL.
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FEES:
VEGETATION • , SEA TURTLE MANGROVE
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DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: T 7 Z PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
_ St.. Lucie County Building and
Zonin
2300Vunia�Avenue
tPirce,F6d FL
S
34982-5652
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
41. LOCATION/SITE ADDRESS;SU�,�� UD '40�7-
2. S/D NAME: i �� �Q� r} Q.R & 54;a-� 5 SITES PLAN NAME: .
3. PROPERTY TAX ID #: - - ?q0o? (o n g 6 y �2 600.3 .
4. LEGAL DESCRIPTION (attach extra sheets if necessary): � D/ A7J 2 r 0 Xve- lcS ? CS'UA h ► -- 09 —
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. _ Ll NO.
9. PARCEL SIZE: ACRES/SQ FT QQ Q� LOT DRAENSIONS U X a
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK A : `2AG S PLC 75 _
7i'rSUt Ti�iti►� y�ALC Gu A.loccasS ` 6V.C1-vS&
] I . SETBACKS (ACTUAL) FRONT: BACK: �Q RIGHT: 1 ri LEFT:
/ SIDES SIDE --',•
r 12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ J INDUSTRIAL,
[ ] ' OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
j14. S . FtJCONSTRUCTION: 15. S . Ft. ist Floor:
116. VALUE OF CONSTRUCTION:
q5�e�
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 consistent with similar types of construction activities. If the value is.S2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02 �.
CERTIFICATION:
OWNER INFORMATION }N
:Sly
•£+ICY /� dP� -i p STATE': : AL . ZIP
PI3 E ( FII IE qt l email:
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): �)
CONTRACTOR INFORMATION
ST: of FL REG./CERT #: (C; - i� ST. LUCIE COUNTY CERT # , ,
BUSINESS NAME-
QUALIFIERS NAME:
ADDRESS: ,
CITY: STATE: s
PHONE (DAYTIME): (_, % FAX NO. email:
STATE: ZIP
BONDING COMPANY:
ADDRESS:. .
CITY: • ' STATE: ZIP
MORTGAGE LENDER:
ADDRESS:
CITY: — STATE: ; . ZIP - - -
IWORTANT NOTICE: When a permit is. issued and it is not picked up within 60 days after notifications
it will be voided and. returned to you"
4
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 use's 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 TIES
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 and zoning.
STATE OF FL A
COUNTY OF U
The foregoin ment c owle ed
ma"IMv,whoisiDersonally
� of 20�by
whoMy— rlW ausMentificatinn_ 4
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was -acknowledged
before me this _ day of , 20_,' by
who is personally
known to me or who has produced
as identification.
Signature of Notary
Typeorr`r PrintNameN/ ame of No�2A�y2� �s Type or Print Name of Notary
Commission No_.. (Se al%s Commission No_ (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN.THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.