HomeMy WebLinkAboutCertificate Of Capacity - Zoning ComplianceOFFICE USE ONLY -
DATE FILED: 1 i %-I 1 t�
PLAN REVIEW FEE A Q RECEIPT NO.: PERMIT NUMBER: 3' a.O q
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
1.
2.
3.
4.
5.
9.
10.
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
- PROJECT INFORMATION
/v
LOCATION/SITE ADDRESS: Z ,(� OO • Al
PROJECT NAME:
PROPERTY TAX ID #: -
LEGAL DESCRIPTION (attach extra sheets
lI
PLAT BOOK 6. PAGE NO. 7. BLOCK NO.
FA
10)W-310 -
8. LOT NO.
PARCEL SIZE CRES Q FT.): 1 . LOT DIMENSIONS: 9 O 5 X I L47S
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12.
13.
14.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION
RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION:
-5 L d.cn-h
16. VALUE OF CONSTRUCTION: $ 501
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
15. SF. FT 1 st FLOOR
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
I
OWNER INFORMATION
NAME: IDLE Gdl t`��fTC _ ,�oW �Gt7N/�' �L�
ADDRESS: N G
CITY: J0M4Gi1-L/I� �L� STATE: �� ZIP:r
PHONE (DAYTIME): (_) 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): L—)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: op
L�S-jq 02_
BUSINESS NAME: 6-
QUALIFIERS
N Q:rri Q, 5
ADDRESS: •�-- /�l� C M
CITY: / . Plex'c C-' STATE:
PHONE (DAYTIME): 7%.. 1f %��-7 ?SAX NO.
ARCHIT/ENGINEER: /L A
ADDRESS:
CITY: YYl S STATE:
PHONE (DAYTIME): C__)
BONDING COMPANY:
ADDRESS:
CITY:
STATE:
ST. LUCIE
CERT #:
ZIP:
Email:
2.sgsq
ZIP:
MORTGAGE LENDER:
ADDRESS:
CITY: 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.
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.
OWNER OR
SIGNATURE
STATE OF I4'0� W-4 -,37, % -. y
COUNTY OF I4 µ k-% ,-J o r\
The foregoing instrument was acknowledged before
me this Zo day of J 1 vn u rS? 20 %4 ,
by `I= c —+1--'1
who is personally known )_ or has produced
identification.
21
Signatpos4406el Py
Notary Public of
Commy, WA% County. New ]eWy (Seal)
My Commission Expls
01 IG ATURE
STATE OF FLORIP4I
COUNTY OF "
The foregoing instrument was acknowledged before
me this I I day of ram' ` 20�
by Z� LY.i Jr Cl
w o s personally known or has produced
NOTARY PUBLIC
STATE OF FLORA
Wres 8/10/2015
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.
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OFFICE USE ONLY BP #: I4d3. dao
SECTION
TOWNSHIP
'3 S
RANGE
a
MAP NO.
ZONING
+
LAND USE
p
{\
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
o��
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
(RADON)
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC B
CT
FEE
PARKS
IMPACT
FEE
GENERAL
SCHOOL
IMPACT
FEE
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIRE/EMS
IMPACT
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
FEE
_
SPECIFY
SUBS
MECHANIC ROOF
ELECTRIC GAS
NON -CONFORMING
LOT OF RECORD
MISCELLANEOUS
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
INITIALS