HomeMy WebLinkAboutCertificate Od Capacity- ZoningBP #: a
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RANGE:
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MAP NO.:
ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
FLR ELV-.
MAX HGT:
CST TYPE:
OCCP TY
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
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LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLDG
HABITABALE
RADO EE
CODE
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IMPACT FEE
AREA
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(RADON)
Y
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
Y
N
SCHOO L
CREDI T
TOTAL
EE
IMPACTFEE
H SCOL O
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
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TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
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REVIEWS
ZONING
ZONING
PLANS
VEGETATION
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DATE
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DATE FILED: O�
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT.NO.: CERT. CAP. NO.: _
ALL INFO T BE MUST COMPLE
TE 8t FILLED 1NTOB E ACCEPTED C PTED
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 02 21
2. S/D NAME: - CC, 'wiz %L SITE PLAN NAME:
! 3. PROPERTY TAX ID #:
1
4. LEGAL DESCRIPTION (attach extra sheets if necessary): Z�s
5. PLAT 6. PAGE A 7.. BLOCK 8. LOT
BOOK NO. NO. NO.
l 9. PARCEL SIZE: ACRES/SQ FT. 000 LOTDIMENSIONS
1 '
I
10. DESCRIPTION
C PTI ON OF CONSTRU
CTION PROJ
ECTOR OR WORK ACTIVITY:
a
t 11. SETBACKS (ACTUAL) FRONT: �' BACK: t RIGHT LEFT
I ��J.S J j a �' S75 SIDE SIDE:
77iv v urc.�.
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
4 [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
jp-r OTHER (SPECIFY)
i13. DESCRIPTION OF PROPOSED USE: —Aw
14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1 st Floor:
16. VALUE OF CONSTRUCTION: $ fo..
! 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.
j 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
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:,����
NAME:
ADDRESS: _��L7 /%�GG.✓ �0 1J
CITY: �/%L�eA�t/ STATE: ZIP
PHONE; ` 2
DAYTIME): (.S/� 17 7�
01`, +4.
i.kE''FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
`'tBEcow.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME): ( 1
STATE:
ZIP
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: C_J - ocoo co � s T. LUCIE COUNTY CERT #: SS 1 b
BUSINESS NAME:-/n)
QUALIFIERS NAME: J'�. "A b q �- 9 }2LSTK w
ADDRESS: yI (-)�'I I1 la-t _ i,
U CITY: &—b 1.?54.4Lyl FL STATE: ZIP
PHONE (DAYTIME): ((IJYA) �� _ CL (03 FAX NO. 1 1 - Ski- - C1 4F!� 13
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE.(DAYTIME): (,@A)
BONDING COMPANY:
ADDRESS:
CITY:
STATE: _rJQ ZIP
STATE:
ZIP
MORTGAGE LENDER:
ADDRESS:
CITY: ° STXTFF t ZIP
I (I
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.
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, 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 and zoning.
OWNER/CON CTOR SIGNATURE CONTRACTO SIGNATURE
STATE OF FLORIDA
COUNTYOF INblWO RIkfEK-
The foregoing instrument was acknowledged
before me this 2 '"-da of , 20D�, by &AYQ0A1
who Cs personally known tom r who
has produced as I en I Ication.
S
Signatute,of Notary
Type or Print Name of Notary
Notary Public Title
&-gkA3_,T Commission Number
o'�'°o Diana LBryant
(seal) ** NN Commission CC902835
104060'� Expires January 17, 2004
STATE OF FLORIDA
COUNTY OF W64 P- M R(vti{2
The foregoing instrument was acknowledged
ioirwhaohas
his '"' , by
/iliW— who is personally know fo me
produce I Ication.
��--••- k6t • y v f�M -_-
1
Signature of Notary
1*�>IiqNxi L• 9k,,WA(T
Type of Print Name of Notary
Notary Public Title
C�.9d�g3SCommission Number
Diana L Bryant
(seal) * W Commission CC902M
3+ia Expires January 17.2004
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.