HomeMy WebLinkAboutCertificate Of Capacity-Zoning ComplianceOFFICE USE ONLY:
DATE FILED: tml 6-b
j PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: a'���✓
i CONCURRENCY FEE: RECEIPT NO.: CERT. CAP: NO.:
ALL INFO MUST BE COMPLETE 8L FILLED IN TO BE ACCEPTED
- �JG�6 t;oGy ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
'20R10Q FORT PIERCE, FL 34982-5652
561-462-1553
4
'APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
r
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: Feb, �Awq
2. S/D NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #: 3qjq 'f l/ C�
4. LEG,AIL DESCRIPTION ((attach extra sheets if necessary):
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
I ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
a
14. Sq. Ft./CONSTRUCTION: 15. Sq. 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 questinn and/or modify the
Indicated value of Construction if It is demonstrated that the submitted figures are not coAsistent with similar types of constructlon activities. If the value Is $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION:
1�
NAME: 1 z_1 (\ en)
ADDRESS: �3Z 5ic-7 Q-0.{1 ®iCt f%"O'(A
CITY: L ZIP
STATE:
PHONE (DAYTIME): .3 l 4R
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW. '
FEE SIMPLE TITLEHOLDER: `
-ox SEA f r�"Trfss
ADDRESS: rN i
CITY: C n k 0, I V STATE: ,L ZIP
PHONE (DAYTIME):
CONTRACTOR INFORMATION % /� /� ST. of FL REGJCERT #: Si: L•UCIE COUNTY CERT #:, -? ` V V
BUSINESS NAME: _ L-7 k7(C72:__ 0_ -V iAf s
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
i
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
STATE: Zip
FAX NO. a2 - q l .3
STATE: Zip
( 1
BONDING COMPANY:
11DDRESS:
✓ITY STATE:
LP
MORTGAGE LENDER:
WDRESS:
ITY: STATE:
LP
MPORTANT NOTICE: When a permit is issued and It is not picked up within 60 days
kfter 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:
WE OF FLORIDA
UNTY OF
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.
V TU E 4NTRA CR SIGNATURE
C-)
'`TTHEWS
STATE OF FLORIDA MC•. -n05
COUNTYOF ocPj {�Par�naliy Known (j:,.
The foregoing instrument was acknowledged The foregoing instrument was acknowledged
before me this day of , 20_, by _ before me this day of . 20 , by
who is personally known to me or who , who is personally known to me
f has produced as identification. or who has produced as identification.
I
Signature of Notary ignature of Notary
Type or Print Name of Notary Type of Print Name of Notary
Notary Public Title Notary Public Title
Commission Number Commission ` ` JASON S. MATTHEWS
i
(seat) y .My Comm Exp.11125r'
(seal) i^" No. DD 074G
p :. 0.
4Y 4v� .�'� 0,¢lSon3liy KnOWf� ---.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEFVBUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATI N.