HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT CERTIFICATE OF CAPACITY - ZONING 3-16-07DATE FILED= I v: J `
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Q 7D3 - �a (Q PLAN REVfEW FEE.50'01 RECEIPTNO__ PERNII r NUN�BER:
CONCllRRENCI! FEE: QS .0RECEIPT , 6__7' '. CERT. CAP. NO-_
- - - -- -- INTO �CO PL
` sALLLD NT BE ACCEPTED PTE D
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ST_ LUCIE COUNTY PUBLLC WORKS
' ^ TO�HtP_ 1�ANGE 2
SECTION_MAP NO-: h j BUILDING R ZONING DEPARTMENT
:, U 3 lG 2300VIRGINIAAVENUE
'`20RlOQ FORT PIERCE, FL 34982-5652
O 772-462--1553
LAND USE , r COT CVG %_ 1 TAZ NO-_
ZONING
FIRM MAP #.. IST FLRELV_ MAX HGf: 3 S ' . APPLICATION for BUILDING PERAUT
FLOOD ZONE I� 5
CERTIFICATE of CAPACITYIZONING COMPLIANCE
OCCP TYPE: MA)C_ OCCP: # OF FLRS:
CST TYPE_ PROJECT INFORMATION F+ r
f�erce
SEWER .SPRINKLERS sTORMWATE 1 _ LOCATION/SITE ADDRESS: �5 a
RYA
WATER R {� { i i-
2_ SID NAME: f la`` 1pt �JC'��7�5 �Vti� SITE PLAN NAME_ 1'it! YPQ�-S �_ILAiIJ
LOT OF REC (aft 1190) LOT -SPLIT LOT SPLIT !, I Q �Q O�O��
LOT OF REC (be€r 1/9t)) REQ'D APPRV•D 3- PROPERTY TAX ID #: Q: ` C�
D / { 4_ LEGAL DESCRIPTION (attach extra sheets i€necessary): 1 of ` _ U Cx. 4-- s D.Im Bree r es
DECAL LIBRARY PARKS bb PERMIT Its• r - g A �q L " j� f (P� .L
IMPACT FEE 1�� t IMPACT FEE -=ISu O® �i C��ie� ��c'35 T� l GD�iC �QCDtr�'j �' '"�. �Q:LCi�°��dJ1414C �.
NUMBER �r 2
REPORT PUBLIC BtDC a `� HABITABALE RADON FEE 5_ PLAT - 6_ PAGE- - _ 7_ BLOCK 8- LOT
1 CODE IMPACT FEES BOOK 9 NO- 2 3 NO_ �Z NO.
D 1 as . 4o -7 (RADON)
AD S r� GROSS ROAD CREDIT Y N TOTAL ROAD 9_ PARCEL SIZE ACRESISQ FT_ 5g LOT DIMENSIONS I 1 1
ROAD IMPACT FEE
IMPACT ZONE I IMPACT FEE DUE 5 1 S , p w)
1 O_ DESCRIPTION OF CONSTRUCTION +PROJECT OR WORK ACTIVITY:
= -
- -- -
TOTAL
PV
SCHOOL- CREDIT SGH00 r
IMPACT FEE
-a— -- - FEE- -- - - -- - - ----- ---- -- -- 'IMPACT
CT
1 SETBACKS (ACTUAL) FRONT_ BACK- RIG
LEFT
_
i
SIDE_
I S!D E
MISC. FEES: 1
POLICE FEE FIRE FEE TOTAL `
nn ' •) 2 DU 60 POUCE/FIRE/ 12_ TYPE OF CONSTRUCTION (Check all appropriate boxes)
��'7 ►/V �' �J , / + , S 9 "1MISC_ FEES
i1J G- j NEW CONSTRUCTION j j EXPANSI.ONIADDITION j INTERIOR RENOVATION
O N TOTAL RESIDENTIAL j 1 - COMMERCIAL. - INDUSTRIAL
ADDITIONAL SPECIFY: 1_ L1'-CT I- I C � L FEES ALL � � � j � -
PERMITS M EC OTHER (SPEG[FY)
{ . 13: DESCRIPTION OF PROPOSED USE GROVE
REVIEWS ZONING ZONING - PLANS.. VEGETATION TURTLE
AMAN 14_ Sq- FtJCONSTRUCTION: ✓O� 15_. Sq_ Ft --1st Floor
REVIEWED BY ExAMtNING:
DATE -0 16. VALUE of C1?MTRUgTION_ $ . a'59 off .Y= _
18
COMPLETE l U _ Tie valise Of eonstrvction is usec5 to:deterrrrine d)e ainbunt of peimit fees _tv be assessed ; JSL Lu4esGounty resenres'tiie ithE jb question 2! i ,or modify the
500,
s i cited valise oYeooshucti if Fs- dernonstrated.that%esubm�ied figuresare not co?ls,stent vr,3h skrn7ar types of coiistiuesiori-activities_ H, the vahre-bv=
1-(:�
or mxe,a RECORDED NoSCe of eum-nencement must be subTrg ted v�nth tiftappbcav - _. .
SLCCDV Form 130_: 001-02 .
CERTIFICATION:
OWNER 1NFORNIATION.
NAME:
C eyi+nx 4-nmes
lot
ADDRESS; }:� CJ zr�"0-.i
�4�'��%�
e STATE: � i 71iP: ,�6
P1IONE-(DAYr1ME): 11) 1 00.0
IF THE FEE SIMPLE TrLEHOLDER (PROPERTY OWNER) iS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL iN NAME AND ADDRESS
BELOW_
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAY TIN'tE): t
CONTRACTOR INFORMATION
ST_ of FL REGICERT ir:
BUSINESS NAME:
QUALIFIERS NAME_ --1�
ADDRESS_
CITY: IBmi n+r ii - ,Fg a Y r STATE_! ZIP 33A
PHONE (DAYT)ME): (0_ t `d 67 FAX No_ 561 53L- 10
b%tt '' G ST_ LUCIE COUNTY CERT #:
ARCHITIENG)NEER:
ADDRESS: [( 0 d V I X 1 E
CFFY: Bpc A. VATO
PHONE tDAYbME): _ y f5U 39R - 3746
STATE: • F^L Z)P
BONDING COMPANY: `•a
ADDRESS: -.-..-
STATE: ZIP
MORTGAGE LENDER
ADDRESS:
This application is hereby made to- obtain a perrnit'to -do the work and. installatioris as, indicated, and. ao obtain a certificate of
capacity, if applicable, for the permitted work 1 certify that no work or installation has commenced prior to the issuance of a permit
and that all work wll be performed to meet the standards of all laws regulating construction in this jurisdiction_ 1 understand that
separate permm its ay be required for ELECTRICAL, -PLUMBING, SIGNS, WELLS, POOLS; FURNACES, BOILERS, HEATEkS",
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 .A 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_ 1
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PER 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 COPY OF THE ATTACHED CONSTRUCTION -LIEN
LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT_
OWNER'S AFFIDAVIT: 1 certity that all the foregoing information is accurate and that all work will be done in compliance
with ail applicable laws regulating construction and zoning-
OVYNERICONTRACTOR SIGNATURE C TRACTOR SIGNATURE
STATE OF iDA f ^ STATE OF FL RIDA
COUNTY O �/ I COUNTY OF
The foregoing- instrument was /acknowledged The foregoing instrument was acknowledged.
before me this t5' day of ftYc 12&L by Qj:N0\-8 - before me this _(.S— day of I�gYCL 20 0 , by
who `personalty known to me orwho--Davldt Akra►m who is personally known to rile
a 7.
produce as identification_ r who ha d as identi-fication_
ig lure o Notary na r of Notary
.��IjOTARy PUBLIC -STATE OF FLORIDA
�'ony mcDonald '� �� i�OURY PUBLIC -STATE OF FLO
T e Print Name of Nota '�Comnission #tJUQS2655 Type of Print Name of Nota 011ya �Ojl l
Expires: JULY 19, 2009 ryI*Expires:
Commission # DD452
Notary Public Title Bendad mlu•u Atianiic Bonding Ca., Inc. JULY _19,. 2
Notary Public Title Rondod !VU AdUntft s�rid g Mgr,
Commission Number Commission -Number
(seat)-
(seal)
cm. STATE: Z)P
' NOTE_ TWO (2) SIGNATURES ARE REQUIRED_ EACH SIGNATURE MUST BE NOTARIZED-.
D3i1�P�R'��►)�iT AD€�'�l�,�o: iiieY� •a° eY�Yii;t �s i ssu.ed andz t is: riot-`.0icked -up Wit is SSE• dg_)* s.. IF APPLYING FOR THIS BUILDING PERMIT AN OWN THE
THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THiS APPLIEATION. after tnotifiicaition if will be voided and lreitji-n6d.to j�o�i 1Y tmailm
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