HomeMy WebLinkAboutCertificate Of Capacity - Zoning Complianceia
OFFICE USE ONLY
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
2 j 2 bj
LAND USE
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LOT CVG %
TAZ NO.
FLOOD ZONE.
FIRM MAP #�
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MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
{,.,
SPRINKLERS
STORM WATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
®-1
AREA
FEE
FEE
LIBRARY
PUBLIC BID
PUBIC BID
PARKS
IMPACT
1MPACTFEE.
IMPACT
FEE
CORRECTION
FEE
GENERAL
SCHOOL
OAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT -.
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
. VARIANCE FEE .
FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC �— GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING F
SUPERVISOR
PLANS
VEGETATION
-SEA TURTLE
MANGROVE`•
CO
REVIEW''
—REVIEW, '
REVIEW
REVIEW
REVIEW
°,' REVIEW-.
-DATE
RECEIVED
DATE.
COMPLETED
INT LALS
t
O1FIfF E. USEI? •Y: ¢
DATE FILED. LO _ (� 2— ��
PI.A?�TFE':`IEW FEE: RECEIPT NO.:
Ct�TCURRENCY FEE: oZ RECEIPT NO.:
PERr411` NUMBER
CERT. CAP. NO.: '
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
r- ={ _ PLANNING &. DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION'
. Pierce,
FL a Avenue
Ft. Pierce, FL 34982-5652
j ,,� r 772-462-1553 0 3
I OCL-A� Fe—(i
APPLICATION for BUILDING PERMIT (9w
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: lQ 1 weeok u-K Rd, -,49 Hs fit ,,
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #: , 4 ! 0 OO n ?j DOO —%
r I
4. LEGAL, DESCRIPTION (attach extra sheets ifnecessary): Op -396 .39- 5 . 2 N. GE Ila
'l - C o . AV- C.cvr 3 3-L-7,ZI)
5. PLAT BOOK 6. PAGE NO. 7.1.BLOCK NO., 1.. LOT NO.
9. PARCEL SIZE (ACRES/SQ Ft.): .LOT DMNSIONS: y
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
inn i1%,. Lt, :r,.,,.� :: n _ a r - ,. . i .L _ 1 t A — — - �.
11. SETBACKS (ACTUAL) FRONT: _ BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check al1 appropriate boxes)
[&KNEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. 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 ofconstruetion if it is demonstrated that the submitted figures are not consistent with similar types of oonstruction activities. Ifthe value is 52500 or more, a
RECORDED Notice of Commencers at must be submitted with tins application.
SLCCDV Form No.: 001-02
�6 as
UPDATED 6125J09
-A& 0 -'s
OWNER INFORMATION �•
NAME: S aWa ID. Cr-O u cq
ADDRESS: (015
CITY: T• Pl > STATE: �� ZIP:
PHONE (DAYTIME): (—7) 6 TIP- P` 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 INFOIRMATION
ST. of FL REG.CERT #: - I L4�J L , ST. LUCIE COUNTY CERT #: 5 57gC�
BUSINESS NAME: PrM M() b1 (e - OfY-V- °.M 0We-A( 5 ' ` V)SiW �:UJJr X 0.
QUALIFIERS NAME:. -F (A I (e- I- - 54L 1rZ;1
ADDRESS: �•-�{I M 4 l
CITY: •+�1 - pier a STATE: V1. �: � 91 %�
PHONE (DAYMiE): (�%�i 37 0"? 1"1 I FAX NO. Email: amC n-*61 L hMWSd
ARCHIT/ENGINEER- SW f 00O(4 P' EW� • I L.# L4'
ADDRESS: or —we
CITY: fevL I STATE: ZIP: " s a
PHONE (DAYTIME): - 7 �
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE: ` ZIP:
STATE:
ZIP:
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 ELECTR'xCAL, 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.
O R OR CONTRACTOR SIGNATURE
STA OF FLORIDA
COUNTY OF IC:Gi�
The foregoing instrument was acknowledged before
me this _f&,._ day of Z_ 20 12
by
who is personally known eor has produced
as identification.
Signa a of Notary
Commission No. 2-1--) oti ) Notary Public State of Florida
�yf = Catherine Mazur,
��� c,_ c My Commission EE039385
9jFor;,,0 Expires 11/02/2014
*Al I A k,&X' A a'
CTOR SIGNATURE
STATE OF FLORIDA
� ,��
COUNTY OF
The foregoing instrument was acknowledged before
me this day of.:J x e_ , 201an,
by
who is personally known Por has produced
of Notary
as identification.
0"aJS'
{�otary Public State of
?atherine Mazur
co o` My Commission EE03
"d Expires11/0212014'
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
it will be voided and returned to you by mail THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
I 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.