HomeMy WebLinkAboutCertificate Of Capacity - Zoning ComplianceA.'� .'
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OFFICE USE ONLY: 44
DATE FILED:
PLAN REVIEW FEE: f CEIPT NO.: PEPHT NUMBER: ` , __ 4n
CONCURRENCY FEE: RECEIPT NO. CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
I
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue CC�
Ft. Pierce, FL 34982-5652 ( n
772-462-1553 f�
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING.COMPLIANCE
INFORMATION
1. I_,OCATION/SITE ADDRESS:�1 iJY\YyP/�
2. PROJECT NAME: 1 SITE PLAN NAME:
3. PROPERTY TAX ID #: aQ_�bl
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. (��� 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): ` t LOT DIMENSIONS: 5 )(
,y
10. COMPLETE DESCRIPTION
CO//P�U 5 �PROJECTOR
R04C T OCl Q,��I
11.
12.
13
14.
SETBACKS (ACTUAL) FRONT: �Q� BACK: f� RIGHT SIDE - 5 LEFT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
DESCRIPTION OF PROPOSED USE:
f j
SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR: ®�
16. 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 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 6/25/09
A
OWN N F�OR1M
/ATIO�(N�
NAME: s l 1 l (� e l�
CITY: �C.Y v STATE: C--r ZIP: CISOc:)—\WR
PHONE (DAYTIME): Q B�T 7, i 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): (_ )
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CONTRACTOR INFORMATION
ST. of FL REG.CERT #:C-,- Ti Z-I ST. LUCIE COUNTY CERT #: �d
BUSINESS NAME: YV I � +
QUALIFIERS NAME: JTIB-PN E's I��y1C3► %1
CITY: GC STATE: r L" ZIP: S)!A `j 6-j
PHONE (DAYTIME): (_ t--V 441 FAX NO. 1 �� Email: ' rl�
ARCHIT/ENGINEER:
NVA
BONDING COMPANY:
ADDRESS:
CITY:
STATE: ' ZIP:
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: ZIP:
EffORTANT 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.
.A
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.
OR CONTRACTOR
STATE OF FL Af �'� �v p
COUNTY OF . WlJyl C,
The foregoi g instrument wassacknowledged before
ejl
mis day of OQ+ 20 1 S
,
STATE OF FL@WA
COUNTY OF .
The
me this 1 � day of
was acknowledged before
P+ 1 20 13 ,
by 0 6 1 J by / I �JV�orha:s
M r
who is nersonall;�ow or has produced who is personally known produced
a 'dentification.
JVA4 —
Sign ture of Notary
has identification.
Si na ure of Notary
r^ 7% __,yNARIAHMILLS Commission No. (Seal)MARIAHMIL
Commission No. �a ��: (SP9fAhTission # FF 023763 Commission # FI
.... Expires June 3, 2017' i :.: `Y . M=FWnSUr3RC0800-357Q
: a, Expires June
`R;qk BondedThroTroFainlnsurance800.38miq fi.= Commc, °,';' BondedThmTroYFainlnsu JJ
ExpiImoBondedThmT70
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH S ED. 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 ONLY
i BP #:
SECTION
TOWNSHIP
I
RANGE
MAP NO.
ZONING
I
LAND USE
I
LOT CVG %
•
TAZ NO.
FLOOD ZONE
FIRM MAP #
i l
15T FLR ELV
MAX HGT
a2,
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
2-
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
I
I
REPORT
CODE
HABITABLE
AREA
(RADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
j
PUBIC BLD
IMPACT
FEE
ARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
F
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
NON -CONFORMING
LOT OF RECORD
i FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING. /
REVIEWS
FRONT
CO
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIFW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
INITIALS
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