HomeMy WebLinkAboutCertificate Of Capacity- Zoning,,
OFFICE'USE ONLY:
DATE FILED: " - & _
PLAN REVIEW FEE: �� ` RECEIPT NO.: �J
CONCURRENCY FEE: ":) 00 RECEIPT NO.:
PERMIT NUMBER: 13 0Z), . 0011
CERT. CAP. NO.:
►"E COMPLETE & FILLED IN TO BE ACCEPTED
P�LA N�NG & I�EV� MkTSERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652 C
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE '
PROJECT INFORMATION
1. LOCATION/SITE AD SS: bl �
2. PROJECT NAME: bi SITE PLAN NAME:
3. PROPERTY TAX ID #: 1 �� -ti =,� (� r` +`c7. CEO)
4. LEGAL DESCRIPTION (attach extra sheets if necessary): _ {lp , PGRC&X,
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): �- LOT DIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
✓ J
11. Af SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE �, LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[�] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[J RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION: `Jo 15. SF. FT 1st FLOOR: U�S�
16. VALUE OF CONSTRUCTION: $ _� �����• I%t'fS
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 6125109
0
OWNER INFORMATION
Mr
NAME: If 11
ADDRESS: (J D
CITY: 0 STATE: ZIP:
PHONE (DAYTIME): �7 a Email: Au
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: �j, J4
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (�
CONTRACTOR 'INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME): c�
ARCHIT/EN/GIINrNEL�ER:
ADDRESS: lj;z -
CITY: 1
PHONE (DAYT ):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
v
LUCIE COUNTY CERT #: � �y
C.
STATE: 1Jr ZIP: J941W�
9 FAX NO. 6zz_1g_t_5Z 1191 Email: JW,
W
STATE:
STATE:
STATE:
ZIP: J05- T z
ZIP:
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.
4F 0
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 ahy 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.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLORID
COUNTY OF
The foregoing instrument was acknowledged before
me this day 20�
by
who is personally known " or has produced
as identification.
hyl),2
OZ{�
Signature of N�ohtary
CES CROUSE
Commission No.1
COMMISSION # DD 875480
o EXPIRES: July 27, 2013
�r oFB o'! Bonded Thru Notary Publ c Underwriters
V
CONTRACTOR SIGNATURE
STATE OF FLORI
COUNTY OF
The foregoing instrumen was acknowledged before
me this day 20 ,
by
who is personally known or has produced
as identification.
a-141 L 6;1fA>L,492 —
Signature of Notary
Commission
AV
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUILDER, 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.
W.-I t
OFFICE USE ONLY BP #: %3oa 00'�?7
SECTION
(�
TOWNSHIP
RANGE
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LAC)
MAP NO.
ZONING
LAND USE
1 1 H
LOT CVG %
G - CD9
TAZ NO.
FLOOD ZONE
FIRM MAP #
3
1ST FLR ELV
B
MAX HGT
1 J� 6"7
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
2,
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
LOT SPLIT
LOT SPLIT
4 I�
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
1
AREA
FEE
FEE
(RADON)
LIBRARY
IMPACT
j
PUBLIC BLD
IMPACT FEE
PUBIC BLD
a
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PARKS
e
"(
IMPACT
IMPACT
i
FEE
CORRECTION
FEE
FEE
ENERAL
SCHOOL
IMPACT
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ROAD
CREDIT
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IMPACT
FEE
EE
FEE
FIRE/EMS
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Y
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DRIVEWAY
ADMINISTRATIVE
IMPACT
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REQUIRED
FEE
VARIANCE FEE
FEE
IIIJJJ
SPECIFY
MECHANIC `� ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING -_LZ
FEES
DATE SENT TO ADDRESSING: 09\/ 13
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNJtR
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
r
P
DATE
COMPLETED
IMTIALS
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