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HomeMy WebLinkAboutCertificate Of Capacity Zoning ComplianceDATE FILED:" PLAN REVIEW FEE: RECEIPT NO.: CONCURRENCY FEE: RECEIPT NO.: PERMIT NUMBER: C�D CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St.. Lucie County Building and Zoning 2300 Virginia Avenue .'��{3Rl©4 • 2t v r� l Ft Pierce, Fi, 34982-5652 77 -46 53 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE lam► �J iC O �� �}1 — PROJECT INFORMATION �d-r2i'�6'. ttJct 1. LOCATION/SITE ADDRESS: !`60? %$ ;5 2. SID NAME: SITE PLAN NAME: . 3. PROPERTY TAX ID #: 14— 571 iIDO —D 4. LEGAL DESCRIPTION (attach extra sheets if necessary): . wo f- 6?a-W -•JS aG 36'/47 73cDez a 13f6 A-7- P i 1940Pf5t Y or- WrOFtJuf G1 Lyi 4� ��zy 2/tt) r>s! r� 2tJ 5. PLAT 6. PAGE 7. BLOCK S. LOT BOOK NO. NO. NO. 1511 9. PARCEL SIZE: ACRES/SQ FT. a-'7 LOT DIMENSIONS 221- F4RQ,E X'e)4.W —.jO%C 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: j rJ�'t- ILLy� l I. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT: N� N /IA- SIDE %_ SIDE 12. 13 14. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] RESIDENTIAL [v]' COMMERCIAL [ ] OTHER (SPECIFY) [ ] INTERIOR RENOVATION [ ] INDUSTRIAL DESCRIPTION OF PROPOSED USE: CD -1-t- ; Sq. FtJCONSTRUCTION: 16. VALUE OF CONSTRUCTION: $ 15. Sq. Ft. 1st 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 OWNER -INFORMATION NAME: IyJ 14 - n n7O ADDRESS: '4&) HG td- rp-W lam: . . CITY: STAVE:.. - - ZIP - PHONE (DAYTIME): 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 INFORMATION ST. of FL REGJCERT #: + LUCIE COUNTY CERT ##: BUSINESS NAME: rt-0- 4-06D 52C-15 LLG QUALIFIERS NAME: _e_d-P*-P2r 7, L�2� ADDRESS: CITY: • —15-�411. STATE: ZIP `25q4q i PHONE (DAYTIME): (_) 20Q :73 77 FAX NO. 9W -_7262 email: ARCHIT/ENGINEER: - ram d2A f-T__ ADDRESS: ),3 CUtf* Ao-z, CITY: - J 1,9v y rhi/ STATE: yZIP PHONE (DAYTIME) - BONDING. COMPANY: ADDRESS: . CITY: STATE: ZIP MORTGAGE LENDER: It/ Jam' 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. 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 APPLICANTi 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 construc and zoning. C � q®WNER/ TRA IGNATURE RCN ATURE STATE OF FL O D STATE OF FL A COUNTY OF COUNTY OF The foregoing instrument was acknowledged The foregoing instrument was -acknowledged ore me this day f�, 2M3 by fore me this da of � , 20 by who is personally who is personally 4� to r who has produced nown to me who has produced as identification. as identification. aiure ofNrataty ` S' lure of Nootary Type or Print Name of Not Type or Print N =off �o SAMANTHA BRANDY t�xrv� SAMANTHA.BRANDT .�o MY COMMISSION #DD688921 -MY COMMI Commission No... EXPIRES: JUN-25, 2011 CommissiorrN € 1"NODD688921 ES:.JUN 25, 2011 Bonded through 1 st State Insurance °�" Bonded through 1st State Insurance NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APP FOR THIS BUILING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION INTHEOFFICE LISTED ON THE FRONT OF THE APPLICATION. For specific instructions see appropriate permit checklist.