HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY - ZONINGr
BP #: 0130 yo-oJ)—
FFICE -USE ..ONLY -
SECTION:
TOWNSHIP:
RANGE:
//
MAP NO.:
ZONING:
/
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
�/f��
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
_
SPRINKLERS
STORMWATE
R
LOT OF REC (bet 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
CODE
PUBLIC BLDG
-IMPACT -
:. HABITABALE
RADON FEE
FEE _
AREA
-
!—�.
(RADON)
ROAD
GROSS ROAD
CREDI
Y
N
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
Y
N
SCHOOL
CREDIT
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA,
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE `
D
_
INITIALS
OFFICE USE -ONLY:
DATE FILED: 4 /, v
PLAN REVIEW FEE: v_ RECEIPT NO.: XPERMIT NUMBER:*66j
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE 8x FILLED IN TO BE ACCEPTED
�c�6 C�Gy�► ST. LUCIE COUNTY PUBLIC WORKS
-� BUILDING 8, ZONING DEPARTMENT
2300 VIRGIPIERCE,
IA AVENUE FAST-
Ap S lJ � n CK
'20RIOQ' FORT PIERCE, FL 34982-5652 lJ i1-u/=�1
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:
2. S/D NAME: 0-t6-LLQ qj TAU[ 1�,SITE PLAN NAME:
3. PROPERTYTAXID#: ����' coca- cooJr
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
�aw�n5-1>S . Aii,-,T' 1, .4 'u( . n
5. PLAT 6. PAGE
BOOK NO.
9. PARCEL SIZE: ACRES/SQ FT.
7. BLOCK
NO.
LOT DIMENSIONS
8. LOT
NO.
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: crcnt�� 0—
to' �t�o' ' c4 le C m�a
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
A-114
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
13.
14.
16.
] NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
DESCRIPTION OF PROPOSED USE: l fylkQ Q A i kb
Sq. FLICONSTRUCTION: 15. Sq. Ft. 1st Floor.
�0
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 similares
types of construction activities. If the value is S25t)0
or more, a RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
a �-' STATE: zlp
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
3ZRCo3 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
BELOW.
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS structures (all types), swimming pools, fences, walls, signs, screen rooms, utility. substations & accessory uses to another non-
1 residential use.
FEE SIMPLE TITLEHOLDER:.�c�k�.v��nL�-� 1►
ADDRESS: 9929 Nov - 1 v> NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
` r t� TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
CITY'y�ebL7 1'L STATE: �Z_ ZIP 3ZR Loa FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
PHONE (DAYTIME): 1m 4-4q2-- of�� YOUR NOTICE OF COMMENCEMENT.
CONTRACTOR INFORMATION Q
ST. of FL REGJCERT ST. LUCIE COUNTY CERT #: OS3
BUSINESS NAME: �1�.YIILYYI Q1111 Sul \o . La .. _ \n r. n
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.
QUALIFIERS NAME: OzxArN�YIn
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
tlY1NYlQh a hti > with all applicable laws regulating construction and zonin
ADDRESS: C,
CITY: STATE: ZIP
PHONE (DAYTIME): FAX OWNER/C RACTOR SIGNATUR CONTRACTOR SIGNATURE - NO. %� - �i0u' ���
ARCHMENGINEER:
ADDRESS: I`I 17'C
CITY: STATE: ZIP
PHONE (DAYTIME): 1
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER:
kDDRESS:
:ITY:
STATE: Lp -
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days
after notification it will be voldgd and returned to you by mail.
STATE OF FLORIDA
COUNTY OF -
The foregoing instrument was acknowledged
be ore me this 4q day of 200-, by _
UVIIIo is pemQaallylnown to me or who
has produced as identification.
Signature of Notary
Type or Print Name of Notary
STATE OF FLORIDA
COUNTY OF
The foregoing- instrument was acknowledged
befo�e'this,�,ay of�20by
o ispers mily knawn to me
or who has produced as identification.
Signature of Notary
C
Type of Print Name of Notary
Notary Public Title Notary Public Title
11A��9
Co'
m er ommission Number
MELISSI' 1. BlA�I�"ORt?
(Seal) '9 o MY COMIMSSION #
1�'oFs�oe EXPIRES: August - .4 (seal) --1SS?� O.13LANDFORD
1-80D&NOTARY FL Notary s:' �sioms, lnc. cah iSs'iON # DD 109859
y� pF�Oa u ,RES: August 14, 2004
,400,�nsoT&NFLt==Se,,;�&Bonding, Inc.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE'MUS*
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEFVBUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.