HomeMy WebLinkAboutCertificate Of Capacity- Zoning ComplianceOFFICE USE ONLY: 43b
^�_^���DATE FILED:d-41`//l %1 `/Jl
PLAN REVIEW FEE: RECEIPT NO.. PERMIT NUMBER lJ
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2Pie Virginia Avenue 3i0_[111 `�
Ft. Pierce, FL 34982-5652 �-�� 1 ` °v' l� `�'�J
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: �0325 S Ocean TX 49 "I
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #: ?�b Z ", /o O' 6
4. LEG L DESCRIPTION (attach extra sheets if necessary): �'7&/ j )5eY v�� S��Gv en-
9SK to,"
5. PLAT BOOK 6. PAGBM. 7. BLOCK NO. 1 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): 2-69 LOT DIMENSIONS: C
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WOPK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: 0 BACK: M� RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: /�/� C�i Y5 15:,"
14. SQ. FT OF CONSTRUCTION: � 15. SF. FT 1st FLOOR: G
16. VALUE OF CONSTRUCTION: $ ,b j p,
Cl
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 $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6t25/09
OWNER INFORMATION
PHONE (DAYTIME): M) aY I - ��] q 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 #: 05q 1 ST. LUCIE COUNTY CERT #: :2
BUSINESS NAME: M lJ r �! W nc) I r(uct) o n inc,
QUALIFIERS'' \NAME: [� J,, N NkIT(), )
V
ADDRESS: C q ;
CITY: n Y-36 STATE: ZIP:
PHONE (DAYTIME): t11� o��� �L��9 FAX NO % z2 J-g1-jq0 Email:
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): (�
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE: ZIP:
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.
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 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 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.
r
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLORIDA \
COUNTY OF sk � CAC P—
The foregoing instrument was acknowledged before
me this 1 day of Dew 20 13 ,
by mQ�s
who is personally known or has produced
Signature of Notary
Commission N
identification.
DAVID N. KNEPPER
Commission # DO 905510
(f s September 25, 2014
Ba edThruTroyFainlnsw/flA080Qqpp019
CONTRACTOR SIGNATURE
STATE OF FLORIDA h
COUNTY OF S, 1—Ul C-\L.
The foregoing instrument was acknowledged before
me this Yday of ® C�v , 20
by RAGt �NNC,6—s
who is personally know or has produced
f—\ as identification.
Signature of N 1 `
,1.�:•sy•., DAVID N. KNEPPER
Commission No '*: Commission 0955 id
�+� �= Expires September 25, 201a
i ...1, BandedThruTmyFain lnsumm w00�•39rar
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.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE.. i µ BP #:
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
-
"D_ZONE.--
1 sT FLR ELV
`
.:.CONST TYPE
OCCUP. TYPE ..
' -
MAX_OCCUP ...,
..
# OF FLRS
�WATEIi
--
--SEWER-_..._.......-
:STORMWATER
— - — - ------
-- - --
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 111990
After 111990
REQUIRED
APPROVED
..REPORT
HABITABLE
RADON
PERMIT
CODE
1®`
AREA
FEE
FEE
LIBRARY
PUBLIC BID
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORREC
.FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IlVIPACT
IMPACT
IMPACT
-FEE ..
FEE ..
.FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADM]NISTRATIVE
,"ACT
REQUIRED
FEE
VARIANCE FEE
:FEE
✓
SPECIFY
MECHANIC ROOF
NON -CONFORMING G
MISCELLANEOUS
-'SUBS
ELECTRIC GAS
LOT OF
FEES
..REQURRDI?
PLUMBING
FEES
~ DATE SENT TO ADDRESSING. /
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER-
REVIEW
REVIEW
REVIEW
REVIEW
REV�W
REVIEW. :.
DATE
RECEIVED
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DAT$
A?. 0/3
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INITIALS
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