HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT CERTIFICATE OF CAPACITY - ZONINGOFFICE USE ONLY
SECTION
i
TOWNSHIP
L'
RANGE
J
MAP NO.
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ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONSTTYPE
OCCUPTYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
(before 1190)1/90)
LOT OF REC (after
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
ADMINST
VARIANCE
LIBRARY
IMPACT FEE
PARKS
IMPACT FEE
PERMIT
FEE
REPORT
CODE
3j
PUBLIC BLD
IMPACT FEE
HABITABLE
AREA
(RADON)
RADON FEE
SCHOOL
IMPACT FEE
GROSS ROAD
IMPACT FEE
DUE
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
SCHOOL
IMPACT FEE
CREDIT
Y
N
TOTAL
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL
PERMITS
REQUIRED -
Y
N
ECIFY
TOTAL
of ALL
FEES
REVIEWS
ZONING
ZONING
REVIEWED BY
PLANS
EXAMING
MISC_
VEGETATION
SEA TURTLE
MANGROVE
DATE
COMPLETE
INITIALS
_
--
C�vif'i
OFFICE USE. ONLY: (� O
DATE FILED:
PLAN REVIEW FEE: ArU - 0 RECEIPT NO.: �=3� PERMITEu /
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County Building and Zoning 2' eed4
Fp 2300 Virginia Avenue N � -
ORI Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE Exa.
PROJECT INFORMATION
1. LOCVIO./(SITFADDRESS: 3 3 d' iAyD/L-fv /� 17 f,rea-e _ �� 3SAS/
2. S/D JA SITE PLAN NAME:
3. PROPERTY TAX ID #: /�i ��" to 0 %-- 0% 2-6y 0 0 4 I LtI e i ` 01,11 - 0m 1
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 19/A T or / tir n r o v f
i3 * 2, Lai C! 4 04 e-/D; -- 2 / SYi'
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO. _QL.c
9. PARCEL SIZE: ACRES/SQ FT. 3 - LOT DIMENSIONS f
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: '-/ )( ¢
I I . SETBACKS (ACTUAL) 'FRONT: BACK: RIGHT: LEFT:' e
/ r% y l / -9 SIDE "% Z. 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: 2 / � 015 C. O�v l Y /`�� L�A7 u.
14. Sq_ FtJCONSTRUCTION: ('i1 CJI• 5W?) ✓ 15. Sq. Ft. 1st Floor:
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
CERTIFICATION:
OWNER INFORMAT ON A
NAME: cT N '4 N� ��,•1
ADDRESS: 3s�3 O/ I N D-C/ o RP -
CITY: F-f T I eticc STATE: ZIP
PHONE (DAYTIME): (7 �a 4'0" y 9 % �o 1 email:
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:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
STATE:
ZIP
ST. of FL REG-/CERT #: C & C 06 Z 0 L 9 ST. LUCIE COUNTY CERT #: -2 ( 0 tG
BUSINESS NAME: G C` 5 �' Oki S TM•�-�� ��
QUALIFIERS NAME: L s 3A C "S e-x-
ADDRESS�3 i L s �• �'%QN��M S
CITY: STATE: 107 ZIP 33
ARCHIT/BNGINEER: fEAtiAA-A INecot'itl
ADDRESS: 200 U) W .-s e_Ou S rAJ Sf
CITY
PHONE (DAYTIME): (3 bib) 73g - 9 7 f z
BONDING' COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE: .0 /
STATE:
ZIP 3z? z O
ZIP
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.
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.
j,�f-cam
NOTICE TO APPLICANT: 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 construction and zo ng
0-�NE'PJCONTPXC-f01 SIGNATURE C TRAC OR SIGN
—S-T-A-T-E OF -FLORID t STATE OF FLORIDA
COUNTY OF COUNTY OF .4 E
The foregoing instrument was a know}�dged The foregoing instrument w acknowledged
b fore e thi day of � 2(6J � by before me this Z3 day o u , 20a5, by
1J-Lr) Ct, c � Ct
,, w�personally LS/v4t¢t�GNe— who is ersona
�kn wn to me or who has produced own to me rwho has pr ed
(� . �¢� t0 as identification. s identification.
ignature Notary j i o f a
(,4..�t.-i C E /-t' LI f' �i c ' . f-` — r� J / �n • P2oPPS
Tvne or Prin am T r Print Name of Notary
AUDREY 8. HUMP .�r, Jeffry M. P
:•;
Commission No. ° : ';�11SSI0: HFiEY Commission Nodle
EXPIRES: DD 190387 ommission 308I93
° M arch r
'-; °; `�` Ecr.Bed Th Notary arch n�Orwriters p R� �im � 07, 2008
NOTE: TWO (2) SIGNATURES ARE EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.