HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT CERTIFICATE OF CAPACITY - ZONINGM
ATE FILED: a�1
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER: On
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
COUNTY2Pie Virginia Avenue n 02 P o
• a �., 9 "`
Ft. Pierce, FL 34982-5652
772-462-1553
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APPLICATION for BUILDING PERMIT X
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
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PROJECT INFORMATION
LOCATION/SItE ADDRESS:
PROJECT NAME: SITE PLJAN NAME:
PROPERTY TAX ID #: 2YO 7 -214 -0001- 001h
LEGAL DESCRIPTION (attach extra sheets if necessary): -% JIS-10 V1 y op 5 °� n k)
--yq ry.L7 t'4ci(0� �Iz-`175— 1�95��9 ' 33J4•!L y7�
PLAT BOOK 6.. PAGE NO. 7. BLOCK NO. 8. LOT NO.
' LOT DIMENSIONS: G 13.9 i •� 6'� y'S� 7��`•
PARCEL SIZE (ACRES/SQ FT.): w
COMPLETE DESCRIPTION OF CONSTRUC N PROJECT OR WORK ACTIVITY d i
. ,1-PAl SsI' JVf'b-e-Q W�RA 1-11IV —ZA -3600 t s -2
SETBACKS (ACTUAL) FRONT./BACK - L/ RIGHT SIDE: LEFT SIDE: '
TYPE OF, CONSTRUCTION (Check all appropriate boxes)
[ , ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [ ] .COMMERCIAL
W OTUER (SPECIFY) j�,�n 4 q 0, *n le ha
13. • DESCRIPTION OF PROPOSED, USE:
14. SQ. FT OF CONSTRUCTION: ;2 V30
16'. VALUE OF CONSTRUCTION: $ ;2 :3 L9 7y
[ ,] INTERIOR RENOVATION
[ ] .INDUSTRIAL
15. SF. FT.1st FLOOR:
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 cotistruction activities. if the valucis $2500 or moro,`a
RECORDED Notice of Commencement must be submitted with this application
SLCCDV Form No.: 001-02
UPDATED 6/25/09
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OWNER INFORMATION
NAME:
ADDRESS:
CITY: —Co r-� P �� e �c-L STATE: 1:7 (_ ZIP: y!V -7
PHONE (DAYTIME): 7 14Y57,3 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: STATE: ZIP:
PHONE (DAYTIME):
.CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
.BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME): (_)
ARCHIT/ENGINEER
ADDRESS:
CITY:
PHONE (DAYTIME): C--)
BONDING COMPANY:
ADDRESS:
CITY:
_ ST. LUCIE COUNTY CERT #:
STATE:
FAX NO.
STATE:
STATE:
ZIP:
Email:
ZIP:
ZIP:
MORTGAGE LENDER:
ADDRESS:
CITY: 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.
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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 separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject strucune
which is in conflict with any applicable Homeowner Association rules,, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
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
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
O R OR NTRAC R SIGNATURE
STATE O ORIDA
COUNTYOF Q
The foregoing instrument was acknowledged before
me this C9,- day of 20 �}
who is personally known or has produced
.'�4' S1tt �llt� S 1 1a33.O as identification.
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this day of , 20
by
who is personally known or has produced
as identification.
Signature of Notary :�Y ;,r °°� Signature of Notary
. :.g` fi. LASHAHNA INGRAM
�i � )J(Nn�S nSS�ION� EE 050558 Commission No. (Seal)
Commission No �� ; .,�L,
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFkCE LISTED ON THE' FRONT OF THIS APPLICATION. `•
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. ;
For specific inftructions see apRropriate permit checklist.
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