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Home My WebLink AboutBUILDING PERMIT CERTIFICATE OF CAPACITYDATE FILED: PLAN REVIEW FEE: -UCJ RECEIPT NO.: ZI / j 2tX: PERMIT NUMBER: 7 �� CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St.. Lucie County Building and Zoning A (f- & 2300 Virginia Avenue • OR�� Ft. Pierce, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 21-06 1. 2. 3. 4. 5. 9 LOCATION/SITE ADDRESS: �V v Aj N I c.n, K cA S/D NAME: SrM PLAN NAME: PROPERTY TAX ID #: :a qD 3 _ So !� LEGAL DESCRIPTION (attach extra sheets. if necessary): PLAT 6. PAGE BOOK NO. PARCEL SIZE: ACRES/SQ FT. 7. BLOCK NO. LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUqTIPN AP—ROOJECT OR ORK A TY: _ 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: SIDE 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] RESIDENTIAL COMMERCIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: ' p-h ID N 8. LOT r NO. � J A LEFT: SIDE [ ] INTERIOR RENOVATION [ ] INDUSTRIAL 14. Sq. Ft./CONSTRUCTION: 6 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 X , CERTIFICATION;` - OWNER INFORMATION NAME: `a? e c t J �t t I '�� _i9 14e q.14k9 W G ADDRESS: CITY: FT e `e STATE:: — ZIP PHONE (DAYTIME): LA C( 9' 6 30 D 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 REGJCERT #: BUSINESS NAME: D QUALIFIERS NAME:P)I I C `a f f ADDRESS: _ b 3 ►Z P' 5 by CITY: U er,8 9'QCtC STATE: ARCHIT/ENGINEER: ADDRESS: CITY: STATE: PHONE (DAYTIME): �) BONDING COMPANY: ADDRESS: . CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: ST. LUCIE COUNTY CERT #: ZIP ZIP ZIP ZIP q�� 3a9�g 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 conciirrency 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. 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 zoning. OWNtR/MNTRA(ffT01CSIG4ATURE CONTkAC1TOR SIGMATURE • • WIWA i� The foregoing instrumen before me this day o Mk �- k-nto m r who h s t s acknowledged f 20Zby wh is personally produced as identification. Signature of �, 80 Type or Print ame of Notary Commission No.. (Seal) COUNTY OF The foregoing instrument w acknowledged before me this A day of 20",by wh s personally own to in or who h s produced as identification. Signatur o otary 10, am CF- Type or Print Name of Notary Commission No. (Seal) NOTE: TWO (2) SIGNATURES ARE REQUIRED. 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 specifi siff iate permit checklist. ;LAY oy _ pAV COMMISSION # DD 190387 AUDREY B. HUMPHREY EXPIRES: March 6, 2007 MY COMMISSION # DD 190387 GlaryPublicUndewriters * Bonded Thru N a EXPIRES: March aF boa; 62007 Bonded Thru Notary public Undenw tern 9B 1 OFFICE.USE=ONLY: BP #: _ OFFICE USE. ONLY.... . ... . . .. . ............ SECTION: TOWNSHIP: RANGE: U MAP NO.: ZONING: LAND USE: LOT CVG %. TAZ NO.: d � FLOOD ZONE: N, FIRM MAP #: 1ST FLR ELV: MAX HGT: G CST TYPE: V OCCP TYPE: MAX. OCCP: # OF FLRS: WATER: to SEWER: /Z3�0 PRINKLERS SRTORMWATE LOT OF REC (befr 1/90) LOT OF REC (aftr 1/90) LOT SPLIT. LOT SPLIT REQ'D I APPRV'D a DECAL LIBRARY PERMIT NUMBER IMPACT FEE FEE REPORT ; PUBLIC BLDG RADON FEECODE/j IMPACT FEE nHABITAJBALE Y N ROAD GROSS ROAD TOTAL ROAD IMPACT ZONE R IMPACT FEE IMPACT FEE DUE J N SCHOOL CREDIT TOTAL IMPACT FEE _:. ... :....... :.._ ..:::..........::: SCHOOL .. ^ .... ;::: IMPACT FEE POLICE FEE FIRE FEE MISC FEES: TOTAL POLIMISC. MISC. FEES FEES Y N E L- EC - ADDITIONAL SPECIFY: 7L V M 2 1, TOTAL ALL PERMITS Et-1+kftVjGc4 L FEES REQ'D Zoo e-i G REVIEWS ZONING. ZONING PLANS VEGETATION SEA MANGROVE REVIEWED BY EXAMINING TURTLE DATE COMPLETE v10-3 INITIALS DATE FILED: j� PLAN REVIEW FEE. �� RECEIPT NO.: 0I1 f PERMIT NUMBER: -�q,-2- CONCURRENCY FEE: c RECEIPT NO.: CERT. CAP. NO.: ALL INFO -MUST REC MPLETE 8t FILLED IN TO BE ACCEPTED �JG�6 COGy ST. LUCIE COUNTY PUBLIC WORKS 'P i - BUILDING & ZONING DEPARTMENT %2 2300 VIRGINIA AVENUE P FORT PIERCE, FL 34982-5652 Op c20R10 561-462-1553 APPLICA ION for. BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: LA t CIM «e ' /` .A'-",Fz- 2. S/D NAME: Ik l7� �`L'1 SITE PLAN NAME: i Lto`3- ")o �-o 3 I D.- ®oo - 3. PROPERTY TAX ID #: � � C f 4. LEGAL DESCRIPTION (attach extra sheets if necessary): wi-&-(Te C1711 31b 3L Vc, A) i/I ` S t% DW el .4,► 9 l.� S� 5. PLAT ] 6. PAGE 7. BLOCK 8. LOT BOOK 1 NO.� NO. NO. 9. PARCEL SIZE: ACRES/SQ FT.1��o LOT DIMENSIONS �0 _ 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: N (E w C'A dV 3 7R.Gf-Cj7c 0/'/ 11. SETBACKS (ACTUAL) FRONT: BACK: / RIGHT LEFT -1,Sq d -0 SIDE ( SIDE: e jI 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) I [� NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1st Floor: 1 16. VALUE OF CONSTRUCTION: $ �� L 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. S:LCCDV Form No.: 001-02 OWNER INFORMATION: NAME: ADDRESS: CITY: PHONE (DAYTIME): �ra ci�"�' G •'lam-e- . STATE: F—L 7 IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. NIA FEE SIMPLE TITLEHOLDER: dy 1 A ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): I ) CONTRACTOR INFORMATION ST. of FL REGJCERT #6: -, C &C-0 ST. LUCIE COUNTY CERT M BUSINESS NAME: / � / G 7 S 6 _7T r V AI rZ./ " C-170,1! �6- QUALIFIERS NAME: fvvi ADDRESS: 1 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, 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. 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 //�� AA4U. n.A CITY: f-olc. J z• C-AACLLx STATE: `'-` zI— — 01IVNER/CONT��TOF_,SI6 s/ PHONE (DAYTIME): i� /� 3 73 S — i 6,67 FAX NO. -.' q a _ 3 �/ —• 3 Y P.a nW-i STATE OF FLORIDA D 1 , COUNTY OF S7 kaeigj57 ARCHIT/ENGINEER: �1 J.L�L.% UA_J tTl � � _/4 IN-C �A �G ADDRESS: _L_! o Z_ _ ) Vv / l L--rr o'e,� 1. !�` t —rig I CITY: Pip t;l 5J�-r L" Cal ar STATE: - l� �— ZIP / PHONE (DAYTIME): ( l P /91 ��lF q / e -9 1ct33 BONDING COMPANY: r v 1� ADDRESS: CITY: STATE: ZIP MORTGAGE LENDER: r 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. 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 zoning. TURE The foregoing instrument was acknowledged before me this " day of ,2,, 20A3, by ,WS#A n/ AkknifioRL, who is personally known to me or who Was produced z as identification. Signatu4i of Notary /-INAA- TUHe- l.LfjflTi Type or Print Name of Notary t-AACTOR SIGNATURE STATE OF FLORIDA COUNTY OF � c`�- The foregoing instrument was acknowledged before me this -I—/ day of J, 20;0 3 , by JgVy i YYie ap who is personally known to me or who has produced ,"1) 1as identification. Signature cW Notary Ain,44y�cAI ;;7 U)HI7--e- Type of Print Name of Notary Notary Public Title Notary Public Title CCjZ4Commission Number ed1Zq5_:s534 Commission Number (Seal) : os'�Y °y% Linda June White (seal) `4Py'� ;- MY COMMISSION # CC845354 EXPIRES ig• �F: Linda June White MY COMMISSION #CC845354 EXPIRES June 1 Q 2003 ` June 1Q 2003 oFF°:' BONDED THRU TROY FAIN INSURANCE, INC .q F:•`` BONDED THRUTROY FAIN INSUR ' f . NOTE: TWO (2) SIGNATURES ARE REQUI49b. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAP, .._ TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.