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HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT CERTIFICATE OF CAPACITY ZONING' _ is ,.. � � � ► '� � _.. MR Ed — DATE FILED PLAN REVIEW FEE: • pO RECEIPT NO.: CONCURRENCY FEE: LYD RECEIPT NO.: PERMIT NUMBER/— CERT. CAP. NO.: ALL INFO MUST BE COMPLETE. & FILLED INTO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE�REGULATIONS DIVISION - 2300 Virginia Avenue Ft. Pierce, FL 34982-5652. •,i � • 1v 772462-1553 �i )I �„/ /�i,,,. �J• ot- APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: -107 1Z4� , Pvd,—( $ is LOG(6- 2. PROJECT NAME: PW44 LC 13 did rot" &S SITE PLAN NAME: 6A4C-f- nANU6(— G' � 3. PROPERTY TAX ID #: '94-t5 — 1701 — 00+1 — 000 — 0 4. LEGAL DESCRIPTION (attach extra sheets ifnecessary): 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): LOT DRAENSIONS: 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: A0 0 rh y E, Fbn<+443l,t—r 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: �t/►zs nl11 CJ��C JuLC.� AJD >� OA&C 62 P/Zt-- K S-fiC40c'Li 14. SQ. FT OF CONSTRUCTION- 'L�'°k �o C-00. 15. SF. FT 1st FLOOR a 417D If-- 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 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 ".1, . �i..', UPDATED 6/25/09 OWNER INFORMATION NAME: Gt-ace Emmanu4=1 Cburcb ADDRESS: -707 K, +,-rrrnan RJ . CITY: 3+. L Lkc- is STATE: F ZIP 3 ^% 10'2 PHONE(DAYT ME): (772) $-35/-978-Q EMAIL: nnc�cccgcrn l C� 6cflso.i . nc(- FILL IN NAME AND ADDRESS BELOW IF THE FEE SIMPLE'TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE: FEE SIMPLE TITLEHOLDER ADDRESS: CITY: STATE:. ZIP PHONE (DAYTIlVIE): (� CONTRACTOR INFORMATION y STATE OF FLORIDA REGJCERT #: 05 5 i _ ST. LUCIE COUNTY CERT #: J BUSINESS NAME: e v :, /J aa � e. QUALIFIER'S NAME: . vies 11 !i cfr'% ►rj ADDRESS: Q4V x^ CITY: - PDf-•r S n . >Ly` . STATE: ZIP 3 S �.- PHONE (DAYTIME): (TIL) 3 10 - OSA CI FAX NO. email:. W.k-n,.J_J'7+mit,; I,- ARCHITECT/ENGINEER: Ab rQ ADDRESS:"�(a8 NW �doevitcr Ayc CITY:= Fa c-1- 54- L:..Qc; c STATE: FL ZIP 34 9B3 PHONE (DAYTIME): 77 .R 7 R-.5o79 NOTE: IF APPLICABLE, SUBCONTRACTOR AGREEMENTS MUST BE ATTACHED TO APPLICATION FOR ROOFING, ELECTRIC, PLUMBING, AND HVAC ZONING REQUIREMENTS All such structures will be subject to the requirements of the ST. LUCIE COUNTY LAND DEVELOPMENT CODE. ❑ 2 scaled plot plans showing lot size, dimensions of existing host structure, and proposed aluminum addition. All setbacks including front, side, rear and distance between adjacent property structures in MH Parks shall be indicated on the plot plan. ❑ 2 sets of color photos for all storm damaged areas to be reconstructed. One picture must include house address number for inspection verification. ( not required for construction unrelated to stones) OFFI SECTION TOWNSHIP RANGE MAP NO. Additional ZONING LANDUSEU Permits Required REPORT BIMS FEE $ MISC FEES $ TOTAL FEES $ CODE FRONT PLANS VALUE OF CONSTRUCTION REVIEW COUNTER ZONING SUPERVISOR EXAWflNER VEGETATION USING ICC TABLE DATE COMPLETE I INITIALS a CERTIFICATION: _. This application is hereby made in order 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. NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU 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: IN THE EVENT IT IS NOT YOUR RIGHT TITLE OR INTEREST THAT IS SUBJECT TO ATTACHMENT, THE APPLICANT DOES HEREBY MAKE A GOOD FAITH PROMISE TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT, AND DOES SO AS A CONDITION PRECEDENT TO THIS PERMIT 1. If utilizing the AAF Guide to Aluminum Construction in High Wind Zones, I the Contractor/Owner Builder hereby certify that the components being used, fasteners type and fastening pattern meet all the requirements for the designated wind zones established by the county and take fax responsibility for complying with the submitted design of the structure being permitted. 2. I further certify that all the foregoing information is accurate, that no work or installation has commenced prior to the issuance of a permit and that all work shall be performed in compliance with all applicable laws regulating construction and zoning in this jurisdiction. I understand. that separate permits may be required -for ELECTRICAL, and HVAC, etc., not otherwise included with this building permit application. 3. I , the Contractor / Owner Builder, have verified that the existing foundation meets the requirements of the Engineer of Record and is in adequate condition to withstand the uplift and weight of the aluminum structure and said structure will not exceed the footprint of the structure thatwas in existence prior to removal by the storms. A OWNER OR CONTRACTOR SIGNATURE COMM CTOR SIGNAAM STATE OF FLOP COUNTY OF r,Sf. Li.lc.r G The foregoing instrument was as acknowledged before me e `) me this G'day of A- T f 20 , r by who is personally known V to me, or who has produced as identification. Signawre ofNotary IMPORTANT NOTICES: DEM44 BOERCK MY COMMISSION #FFoU EXPIRES Apnl 12.2017 STATE OF FLO" COUNTY OF \st Lwi e_ The foregoing instrumentwas acknowledged before me me this ` day of .204, by who is personally known V-1lto me, or who has produced as MY COMMISSION #F EXPIRES April 12, • TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOW " BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR, IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION, TO SIGN THIS APPLICATION & THE O'V ER BLDR AFFIDAVIT. •_ ALL SIGNATURES ON APPLICATION SUBMITTED SHALL BE ORIGINAL, SIGNED IN INK. COPIES, FAXES, OR STAMPED REPRODUCTIONS ARE PROHIBITED. • WHEN A PERMIT IS AVAILIBLE FOR ISSUANCE BUT IS NOT PICKED UP WITHIN THIRTY (30) DAYS AFTER NOTIFICATION OF AVAILIBILITY, IT WILL BE VOIDED. IF THE APPLICATION IS RESUBMITTED, AN ADDITIONAL FEE WILL BE CHARGED. CERTIFICATION: ' Ibis application`i's 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 willbe 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 norepresentation that its granting of a permit will authorize the permit holder to build the subject- u ctire 'Vvhich is in con$iot with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibii 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 IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON T B E JOBSITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULTS 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 ATTACIRVIENT: 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 CONTRACTOR SIGNATURE LATE OF FLO :)UNTY-OF l 1e foregoing instrument was acknowledged before= tfiis ' JR+fty of 20 !mown V or has produced DEBORAH BO�R�ICEL MY eeivI19 ISSION FF0 1316 EXPIRES April 12. 2017 398.01 STATE OF FLO I COUNTY OF , The foregoing instr me this T2gy by was acknowledged t efore of- , 20k who is personally known V or has produced 53 RAH BOERCKEL EXPIRES April 12. 2017 (2).SIGNATURES ARE -REQUIRED. EACH SIGNATURE MUSTBE NOTARIZED. IF APPLYING FOR -BUILDING PERNIIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION ER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. tic instructions see appropriate permit checklist. 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 COIN" ACTORSIGNATURE STATE OF FLORMA COUNTY OF LT , U10 The foregoing instrument was acknowledged before me this _L+11day of q by Aftr-+ AAJ�l who is personally known �or has produced CONTRA R SIGNATURE STATE OF FLO ,, ++ ^' f COUNTY OF �'� L-Ll(1 V P. The foregoing instrument was acknowledged before { me this ! (t',day of 20� by who is personally known ___L._/or has produced as identification. as identification. ignatur ._ of Signature of Notary MION ,W 80E L s ppYPul s DEBORAH BOER b Commis i Com i i sY�tr 5ION #FF001316 t�NFF001316 �0 EXPIME April 12, 2017 °'6pf o? EXPIRES April 12. 2017 i B�0, I � f I©fl�aN®la ®fVica,com (407) 398.0153 FloridallotarySenice.com 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 BUELDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist.