HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT CERTIFICATEVOF CAPACITY - ZONINGSECTION:
ZONING:
F LOOD ZONE:
CST TYPE:
t--
WATER:
LOT OF REC (befr 1/90)
DECAL
NumBER
� REPORT
t CODE
ROAD
IMPACT ZONE
SCHOOL-
IMPACT- FEE
POLICE FEE
ADDMONAL
PERMITS
RECYD.
REVIEWS
DATE
COMPLETE
TOWNSHIP: I I RAt iGE
LAND USE: I I LOT CVG %:
FIRM MAP ti:. 1ST FLR ELV:
OCCP TYPE: I . I MAX OCCP:
SEWER: ' f SPRINKLERS
,LOT OF REG (aftr 1190) LOT SPLIT
REUD
LIBRARY
IMPACT FEE
PUBLIC BLDG
IMPACT FEE
GROSS ROAD
I pAur FEE
DUE
CR
EDIT
FIRE FEE
Y ►a
SPECIFY:
PARKS
IMPACT FEE
HABITABALE
AREA
(RADON)
CREDIT
s� =
Y.3'.
MISC FEES:
ZONING ZONING PLANS
REVIEWED BY EXAMINING
MAP rto.:
TAZ NO.:
MAX HGT:
1f OF FLRS-%
ST ORIVIWAT E
R
LOT SPLIT
APPRV'D
PERMIT
RADON FEE---,
Y N
TOTAL ROAD
IMPACT FEE
T FEE
- MPAC 9
TOTAL
4OUCEFIREf
MISC_ FEES
TOTAL ALL I
FEES
VEGETATION { SEA
TURTLE
DATE FILED: 31 1w! V-
PLAN REVIEW FEE: RECEIPT NO_: PEP—NDT N131VIBER: n7D3 � OZIo`1'
CONcURRENCY FEE: RECEIPT NO_: CEPT. CAP- NO-:
ALL INFO MUST BE COMPLETE- TILLED 1 .. TO BE ACCEPTED
C�G ST_ LUC1E COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
0R`�P FORT PIERCE, FL 34962-5652.
i 772-462-1553
i -
XP PLXC TION for BUMIDING PERMIT
CERTIFICATE of CAPACITVZONDIG COMPLIANCE
PROJECT INFORMATION
1 _ LOCATION/SITE ADDRESS= qc�� 1� o l C
�) I r l l I�-� �1 'L vC
2_ SID NAME: �Qr��zes��� SITE PLAN NAME:me.lIAIa
3_ PROPERTY TAX )D I?: DO — con
tt_ LEGAL DESCRIPTION (attach extra sheets if necessary): L.._D� t� N * . , IRA f'C_m 5
I i1� -PEA- Book 4q T0' e5,. 3Q-35 of +b,ETAI-c ' ov-d5 •. +. �L�eteCouy►-t-�r�.
i _
5_ PLAT. 6_ PAGE- - 7_ BLOCK •B_ LOT
I _ BOOK NO_ Z - IA10_
I
9- PARCEL SIZE: ACRES/SO FT_ t C-) LOT DIMENSIONS
I /
i
O_ DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
II' SETBACKS (ACTUAL) FRONT: BACK- RIGHT LEFT
SIDE
SIDE:
1
4
12_ TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSIONIADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ j INDUSTRIAL
OTHER (SPECIFY)
I3. DESCRIPTION OF PROPOSED USE: ���t� � � tI VT SX.C.L 1?' ykC P -
mAI
(GROVE 1.q_ Sq- Ft-ICONSTRUCTION: "L .15_. Sq_ Ft_ 1st�Floor_ l
16- VALUE OF CONSTRU GTIOI>I_
The valve of conshon uctiis used to detenTine the amount of permit fees Ib be assessed_ SL Lucie County reserves the right to question andlor. .. `Fy � e
it ca ed Value of°ccnstrL li —.if it 1s dernonsi;ated.that the su� figutes ars not c c si stent with sim?ar types of construtt�orr acthribes_ tf tine val3e-is-S2�
er mere, a RE CUORDED t4otica of Cornrnencernent must be submitted with th s app&cat%n,
SLG�-DV Form No.: 001-02
nWN'ERINFORINiAT1ON:
NAME:
ADDRESS_
4113►1�1��1 L1� �} STATE_ F ( ZIP
CITY= L l
PI)ONE (DAYT)ME:)-_ _l 1) 36- l cno
IF TI IE FEE SiMPLE Tnt_EHOLDER (PROPERTY OWNER) iS DIFFERENT FROM TIIF OWNER LISTED ABOVE, PLEASE: FiLL 1N NAME AND ADDRESS
BE L OVV.
FEE SIMPLE TITLEHOLDER:
ADDRESS
cITY:
pi-io iE (DAYTImE):
CONTRACTOR INFORMATION
S-r, of FL REG.ICERT ir:
BUSINESS NAME=
QUAL)FIERS NAME:
ADDRESS:
CITY:
---PHbmJ (DAYTIME):
ARCH)TIENG)NEER:
ADDRESS:
Cm:
F'1-10NE (DAYT)rAE):
BONDING COMPANY:
ADDRESS.::
CITY: F
I%,40RTGAGE LENDER:
ADDRESS:
CITY:
CERTIFICATION.
This application is hereby made to" obtain a permit to do the work and. installtioris as irrdicaled, and .to
capacity, if applicable, for the permitted work i certify that no worobtain a certificate of
and that all work will be erformed to. k or installation has commenced prior to the issuance of a permit
pmeet the standards of all iaws regulating construction in this jurisdiction_ I understand that
separate permits may be re"gtiired for ELECTRICAL, PLi MBING, SIGNS, WELLS, POOLS, FURNACES. BOILERS, 1 IEATEF2
TAI',]KS, AND AIR CONDITIONERS, ETCnot otherwise.inciuded with this buildin S'
g permit application_
The following building permit appli( lions are exempt from undergoing a full concurrency review_- room additions accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substation
residential uss 8 accessory uses to another non-
e.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMEi`10EMEi]T MAY RESULT 1N YOUR PAYING
TWICE FOR IMPROVEMENTS TO 'YOUR PROPERTY- IF YOU INTEND TO OBTAIN.
STATE: ZIP FINANCING, CONSULT WITH YOUR LENDER, OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT
NO I ICE TO APPLICANT:'AS THE APPLICANT FOR THIS BUILDING PER IF IT IS NOT YOUR R)Gi-1T TITLE .AND
INTEREST THAT IS -SUBJECT TO ATTACHMENTf- AS A CONDiTION OF THIS PERMIT YOU
PROMISE IN GOODFAiTH TO DELIVER A COPY OF THEATTACHED CONSTRUCTION -LIEN
(� ST_ L�C1E COu;:TY CERT ;1: LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT_
=-s-y
4c), Yrip
UVVNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be_done-in-compliance--
with ail applicable laws regulating
construction and zoning- -
C
-STATE = ZIP
_._
u��
F f
FAx 1IO_ e' �ts- ��� e� '
OO WN'E CnNT 1 CTOR SIG'NA U'
-
«• O. R StCCNATIJJ
STATE OF F RDA f
QRE tJNAN � GILI
,,
COUNTY OF . GEC" 1
STATE OF FL"DA
COUNTY
E��G
OF Ch
O O - I A i E
I G {-11 W rA
The foregoing- instrument was acknowled ed _ .
before me this � day of ��0�by
The foregoing instrument was acknowledged
bef;,r
(�
�r
_
' �DCTn
sTATi=: �. �P -�
_
,2- _ ho is personalty known to me orv,�ho'
e ihis �da of
Y ,29t; > by
1���) ?i9o� - 3 %^q 8
s produced as. identification-
- who is personally known to me
ho has produced
as identification-
/p
Signature of Notary
_
Signature of Notary-
�Prin Yf
Type oName Notary�`�`-'�
STATE: lip
Type of Prin Name of Notar} --
STATE:
Z]P
' IiYdl :t� .-A_i-SD`�. i .,l'�.�) tFs �-. �7,�.ilC�i •"d: ie�'A�iSl� B$' iLJSi.1 L- I�.E �11 LSS'- L �S. t"j. n:•�:'-'1��` v ..s.
k.Illi�liC� '43�2 ��1Tiil�'BBYT �:�''Laa?�S
after 1:10 ilica-lion it will be »oiaed aaaa ]-eia>!r'n';eo. d yoi 'sy_ Trai its
iqoiaiy Public Title
NotarV Public Title
Commission•Number
EO:".6
AI��ySS1XiLlss$El, u tier
®�°�a Notary Public State of Florida Kathy Ingemoll
(se ly Kathy Ingersoll l My Comrrnssion DD458603
My Commission DD458603 )_Expires IO123/2009
'��° Expires i0/23/2009
NOTE: TWO (2) SIGNATURES ARE REQUIRED_ EACH SIGNATURE MUST BE NOTARIZED_
IF APPLYING FOR TNiS BUILDING PERMITAS AN OWNEiVBUILDER� THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS AppL)CATiON IN THE OFFICE LISTED ON THE FRONT OF THjS APPLICATION.