HomeMy WebLinkAboutCertificate Capacity & Zoning ComplianceFFICE USE ONLY
SECTION 3 TOWNSHIP S RANGE J , I jam_
ZONING LAND USE LOT CVG % [4Q. l
FLOOD ZONE I r ' fl I FIRM MAP # I ' 4 1ST FLR ELV
I CONST TYPE
OCCUP TYPE
MAX OCCUP
�. 77.7777
ih-i 0& EEO 1 bFFI E'T SE,QNL y n
CP 5
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.:�n PERMIT NUMBER:
MAP NO. a CONCURRENCY FEE: o� d 0 RECEIPT NO.: d ' `- CERT. CAP. NO.: i tan el
TAZ NO.
'S5
MAX HGT
# OF FLRS
SEWER
1 /
SPRINKLERS
STORMWATERT
:WATERZtPU
OF REC LOT OF REC (after S LOT SPLIT LOT SPLIT
fore 1/90) 1/90) REQUIRED
nrt eat -�--an + Ct :::.....
ADMINST
LIBRARY Pt
I
19
PARKS
L(g(r
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLD
�US
HABITABLE
RADON FEE
46e-,
�-
CODE
I o I
IMPACT FEE
AREA
(RADON)
-7
-
S T5TL
GROSS ROAD
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
a`i7L
IMPACT FEE
_ I ��
IMPACT FEE
DUE
SCHOOL
CREDIT
Y
N
TOTAL
IMPACT FEE
�� j�5
�
z
r .,.........
SCHOOL
IMPACT FEI ,
FIRE FEE
MISC FEE
f A4
l AL
V
X,OLICE FEE
f�
c FE
POLICE/FIRE
MIS C FEES
ADDITIONAL
Y
N
SPECIFY
eL EC
�,(/fy1�3/I�%
� S
TOTAL
of ALL
PERMITS
REQUIRED
_
FEES
REVIEWS
ZONING
ZONING
PLANS
ISC.
VEGETATION
SEA TURTLE
MANGROVE
EVIEWED BY
EXAMING
1/L
DATE
6(
129
7aE'�7
G
"� Q
COMPLETE
l
�d
j /< I
e
INITIALSP-6
_V
�/ ✓ `
ALL INFO MUST BE COMPLETE & FILLED IN TO BE_AjC_CEPTTED_��j =
bth "I
St. Lucie County Building and Zoning "
2300 Virginia Avenue
�ORID Ft. Pierce, FL 34982-5652��
772-462-1553
to ce
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING- COMPLIANCE -
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:
2. S/D NAME: 1j/a 1 Q✓'sv YI f SITE PLAN NAME:
3. PROPERTY TAX ID #: Z S 3 Z- Soo -- O o lf% O o D —6
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 13e(ptar Zvr 2 312 Cr/.t
l f �/ lCfoy 'a
5. PLAT , / 6. PAGE 7. BLOCK - 8. LOT 33
BOOK 'T Z NO. 3 NO. �! t� X (�NO�O2 x
ORES/S FT�� 74'�
IMS Z 80 LOT DENSIONS �` , Z/ oZ -r �0 �
9. PARCEL SIZE A Q _
10. DESCRIP ION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: Al '-w �-rMs%YG G
J �
11 SETBACKS (ACTUAL) FRONT:, F' / BACK: RIGHT: / LEFT:
�% SIDE SIDE (�
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ NEW CONSTRUCTION [ ] EXPANSION/ADDITION [I INTERIOR RENOVATION
[ RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
II13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: (7 Z 264d.1 V 15. Sq. Ft. 1st Floor: 2bq
11, VALUE OF CONSTRUCTION: ,y� ��yU
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 12500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
r
CERTIFICATION:`
OWNER INFORMATION
NAME: �R v11 PS ' U STD J'J
ADDRESS:
� ZIP
CITY: Ile STATE:
Sjj� 9 y 2 _ 03/ % email:
PHONE (DAYTIME): ( ) ,
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:
STATE: ZIP
CITY:
PHONE (DAYTIME).; -
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: C c
BUSINESS NAME: _
QUALIFIERS
�N�AMEy
ADDRESS J j
- (y(1
CITY: -- /
PHONE (DAYTIME)
ey.
s
ST. LUCIE COUNTY CERT
/ STATE: �-
�) 7Y�%�G YUG FAXNO.
ARCHIT/ENG`INEER: G 4, ,' c
ADDRESS: b (OS n
CITY: 13 U C& 4( A'
//� ST
PHONE (DAYTIME): (� 7 S U J d yYS
BONDING COMPANY: 11 A
ADDRESS:
CITY:..
STATE:
MORTGAGE LENDER: / ` - cz crvu"n 1?,qh (C
zIP /3 3 Y 'fir
email:
L zip 3
ZIP
ADDRESS: l U S Gt v P �y_! ° ��'►s
CITY: e / STATE: �— ZIP 32 % O�
Cam/Z CS' l iL�'Y cJ
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.
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 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 anst
d zoning.
a/
X14;�c
bQNT ACTOR SI NAT
CON RACTO SIGNATURE
STATE OF FLORID STATE OF FLO
COUNTY OF COUNTY OF
The foregoing instrument s acknowledged The foregoing instrume s acknowledged
b
e me day o , 2Q2�, by bef me th' day, of , 20, by
who is personally who is personally
to or who has produced own tom or who has produced
as identification. as identification.
4
Signature Aof Notary.
Sgnature o�tarv'
o
Type or Print Name of Notary ��yzr P4B FRANCES CR®USE Type or P taz-'-tea -
`�yrP�.
MY COMMISSION 1 DD446108 '�, BRAN > G✓R USE
Commission No. EY.FIREs: July27,Z009 ; Commissi n v °^. _ _.(rl D446108
q
(407) 398-0153 PlAda fdclary $ervicoxam ' "�'OF;P' G}w : ;_ �, Ju:y27, 2009
(407) 398-0155 PC 1 -! SarAbe com
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF 'AP 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.