HomeMy WebLinkAboutPermit Certificate Of Capacity- ZoningY.'
OFFICE USE_ONLY:
DATE FILED:
PLAN REVIEW FEE:RECEIPT NO.: PERMIT NUMBER: g,
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
2.
3.
4.
5
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ALL. INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION"'
2300 Virginia Avenue ,
Ft. Pierce, FL 34982-5652 e( I Qck ''-
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE
PROJECT NAME: flute% SITE PLAN NAME:
PROPERTY TAX ID #:`J�`
LEGAL DESCRIPTION (attach extra she if necessary):
PLAT BOOK 6. PAGE NO. )`,), 7. BLOCK NO. ' 8. LOT NO. �y
PARCEL SIZE (ACRES/SQ FT.):. PN^5 I LOT DIMENSIONS:
10.-.-. ' COMPLETE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRO
12. TYPE OF CONSTRUCTION
NEW CONSTRUCTION
RESIDENTIAL
[ ] OTHER (SPECIFY)
BACK: RIGHT SIDE: jC� LEFT SIDE:
all appropriate boxes)
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COI,SMRCIAL [ ] INDUSTRIAL
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: �(j 15. SF. FT st FLOOR:�J b
VALUE OF CONSTRUCTION: $
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 similariypes 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
UPDATED 6/25/09
OWNER INFORMATION
NAME:
ADDRESS:�oi �e�eS1
CITY: S-eK SES CAA STATE: 1 L ZIP:
PHONE (DAYTIME): �( QQR-' t 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:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
STATE: ZIP:
ST, of FL REG.CERT #:a,C-pt`-�:`3 ST. LUCIE COUNTY CERT #:
BUSINESS NAME: J,�j
QUALIFIERS NAME: 1A- N �.
ADDRESS:\,:,\
STATE: L ZIP:�1�
s
PHONE (DAYTIME): l�`� 'c� a` \�`l� FAX NO.-�-\'a -,Ago - L Email: _
ARCHIT/ENGINEER:
ADDRESS:
CITY: I t" �A��C�U� STATE: F L ZIP: 3y�g. ti
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP:
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 6060 days after notification
it will be voided and returned to you by mail.
IR,
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, 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 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 filll 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 PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
TURE
STATE OF FLORIDA
COUNTY OF � ,
The foregoing instrument was acknowledged before
me this 7� day of CCt 20 \a,
who is personally known or has produced
as identification.
Signature of Notary
STELLA M HUT*1)
's Notary Public - State of Florida
•_ My Comm. Expires Jan 23, 2015
Commission # EE 31278
CONTRACTORSIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this_j>�_day of r_*_-�C� , 20 \3 ,
who is personally known Chas produced
as identification.
Signature of Notary
''r'' " M HUAf _� —
Notary Public - State of Florida
My Comm. Expires Jan 23, 2015
Commission # EE 312�78pp
NOTE: - D. EACH SIGNAT d �n�uZEDPal NWary-gsS ING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST 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 BP #:
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
j
1
1ST FLR ELV
MAX HGT�
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
I
�l
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
RADON
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BID
IMPACT
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
AD
IMPACT
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 —U4
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REYIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
IILd ILA
DATE
COMPLETED
IU '
INITIALS