HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT CERTIFICATE OF CAPACITY - ZONINGOFFICE USE ONLY BP #: L 11 u — of `s
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LOT OF REC
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After 1/1990
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IMPACT FEE
IMPACT
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FEE
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Y
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IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
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DRIVEWAY
ADMINISTRATIVE
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VARIANCE FEE
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SPECIFY
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NON -CONFORMING
MISCELLANEOUS
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LOT OF RECORD
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DATE SENT TO ADDRESSING: /
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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INITIALS
OFFICE USE ONLY
j DATE FILED: I�i RECEIPT NO.:
PLAN REVIEW FEE_
CY FEE RECEIPT NO.:
PERMIT NUMBER: I® S
CERT. CAP. NO.: -
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ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES�DS OARTMEY7
BUILDING &CODE REGUL
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553
v
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
of
1. LOCATION/SITE ADDRESS: I
2. PROJECT NAME: (A FS 1-I 11 SITE PLAN NAME:
non
3. PROPERTY TAX ID #: !�l '12 O 1 Q -
4. LEGAL DESCRIPTION (attach extra sheets if necessary): o t G
P �} n 2 �k -►
7. BLOCK NO. 8. LOT NO. _
5. PLAT BOOK o2 a 6. PAGE NO. �-7
- DIMENSIONS: o? rl I . b tp x 5 -4� x oZ
9. PARCEL SIZE (ACRES/SQ FT.): U� 1 S 8 `I LOT DIME
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: ^ is
10.
^ / C Ir�S
RIGHT SIDE:
_� LEFT SIDE:—..,
T—
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11. SETBACKS (ACTUAL) FRONT: BACK:
TYPE OF CONSTRUCTION (Check all/appropriate boxes)
[ ] NEW CONSTRUCTION
[ ] RESIDENTIAL
OTHER (SPECIFY) q
DESCRIPTION OF
SQ. FT OF CONST
VALUE OF CON.'
The value of construction is used to deten
value of construction if it is demonstrated
RECORDED Notice of Commencement c
11 SLCCDV Form No.: 001-02
EXPANSION/ADDITION
[ ] COMMERCIAL °
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
15. SF. FT 1st FLOOR: `r
/lam.
_ o
'r 00 C)8_ j
sessed. St Lucie County reserves the right to question and/or modify the indicated
ent with similar types of construction activities. If the value is $2500 or more, a
UPDATED 6/25/09
M
i MON:
o7aZ 1(o by made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
C �a� tC I certify that no work or installation has commenced prior to the issuance of a permit and that all
OWNER INFORMATION
�"' omitted work.
�+ v c.r I to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
!
ct " f
L 3 y G
LEcTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
NA ME: p
--5�' A I'
)HERS, FENCES, ETC., not otherwise included with this building permit application.
_ _
ADDRESS: _ . �e� , K.1 C- - ,
�s no representation that its granting of a permit will authorize the permit holder to build the subject structure
CITY: _ - `- : •-• "` �, +�,STATE:
th any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
PHONE (DAYTIME): (�2) 02 a 3 a
- ZIP: 3
—It with your Homeowners Association and review your deed for any restrictions which may apply.
�ci
Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER)
IS DIFFERENT FROM THE OWNER LISTEIlg permit applications are exempt from undergoing a full concurrency review: room additions, accessory
FILL IN NAME AND ADDRESS BELOW.
swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non -
FEE SIMPLE TITLEHOLDER: n A r-
ADDRESS:
I R: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
CITY: STATE:
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
PHONE (DAYTIME): L�
Z�' FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
[CANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
CONTRACTOR INFORMATION
�. 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
ST. of FL REG.CERT #: 1 oL.s oZ3 B $
ST. LUCIE CO DTI' CEO _ THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACIDAENT.
BUSINESS NAME: C,�j - � I _AA C-0 M S k r % nix
QUALIFIERS NAME: R 1
ADDRESS: o . Olt r -1
A S
CITY: �b ,. a i t3 STATE:
PHONE (DAYTIME): 070 03 O 6 o 4 FAX NO. a,23 Oro 8 d E &\ ZIP
ARCHIT/ENGINEER:----Cr
ADDRESS: 1 L 3 S 5 -1 n'd; GA
CITY: IfA u CLr I STATE:
PHONE (DAYTIME): -t Z g 7 73 3 U
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
ZIP:
ZIP:
IMPORTANT NOTICE: Wh' en a permit is issued and it i^ not picked up within
it will be voided and returned to you by mail.
ument was acknowledged before
of O c..-1 20 l I ,
I r known _Zor has produced
as identification.
CON RACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF M ar n
The foregoing instrument was acknowledged before
me this _day of o c_ � , 20 l L ,
by
who is personally known e or has produced
-1&4wfication
BRANDY WATLEY
BRANDY WATjg Com e { Notary Public- State AW16
lie - State of Florida S�� ��. My Comm. Expires May 9, 2014
My Comm. Expires May 9, 2014
Pc '•io�� ��;.•` Commission # DO 989743
0 Commission # DO 989743
D. EACH SIGNATURE MUST BE NOTARIZED.- IF APPLYING FOR
1LDING PERMIT AS AN OWNERBBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
',LICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
WELDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
structions see appropriate permit checklist.