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Home My WebLink AboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYSECTION: TOWNSHIP: 2 S RANGE:- " C/ MAP NO.: ZONING: LAND USE: LOT CVG %: TAZ NO FLOOD ZONE: FIRM MAP #: 1ST FLR ELV: MAX HGT: CST TYPE: U OCCP TYPE: MAX. OCCP: # OF FLRS: WATER: SEWER: SPRINKLERS STORMWATE R LOT OF REC (befr 1/90) LOT OF REC (aftr 1/90) LOT SPLIT LOT SPLIT REQ'D APPRV'D 0 1 Q 1 DECAL LIBRARY IR PARKS J/� QO PERMIT NUMBER IMPACT FEE IMPACT FEE ltiD, FEE I REPORT PUBLIC BLDG�' a31" 33 HABITABALE RADON FEE CODE IMPACT FEE ''tJ ' AREA75 �� (RADON) !l Y N ROAD GROSS ROAD CREDIT TOTAL ROAD IMPACT ZONE 3 IMPACT FEE DUE �j O n LCA()c IMPACT FEE 1. Y SC HOOL CREDI T TOTAL IMPACT FEE 4 O SCHOOL a a. IMPACTFEE j Q.. P@ME FEE 01D. FIRE FEE MISC FEES: TOTAL - POLICE/FIRE/ x MISC. FEES Y N ADDITIONAL SPECIFY: / v0413 � �'t� ! —J/ TOTAL ALL PERMITS FEES REQ'D ate' REVIEWS ZONING ZONING PLANS 'VEGETATION SEA MANGROVE REVIEWED BY EXAMINING TURTLE DATE /B/68 DS �` 3 COMPLETE � INITIALS UFr_GE,LUSakNLY. GATE FILED: `3' PLAN REVIEW FEE: 0 J RECEIPT NO.: �I PERMIT NUMBER: 050- CONCURRENCY FEE: ZS' RECEIPT NO • CERT. CAP NO.: ALL INFO MUST BE COMPLETE FILLED IN TO BE ACCEPTED >.s-F Cxed*c �- y��6 COGy� ST. LUCIE COUNTY PUBLIC WORKS ® BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE 0R10P FORT PIERCE, FL 34982-5652 772-462-1553 APPLICATION for ]BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION C-k 1. LOCATION/SITE ADDRESS: -b f C,+P, go1�Q 2.' S/D NAME: SzAR 13ORbt i ( $SITE PLAN NAME: 3. PROPERTY TAX ID #: 33�- �j 02 - Q d �p - pv 4. LEGAL DESCRIPTION (attach extra sheets if necessary): -See- P'TA9c (-t-e Q 5. PLAT, 6. PAGE • 7. BLOCK •8. LOT I BOOK NO. NO. NO. I 9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS _1 BYO X I I� • SS-) X l LWX 91. 14.7Lo 10. DESCR IPTION I TON OF CONS TRUCTION CTION PR OJECTOR TOR WORK ACTIVITY. /U�W nnW� 1�STRUQloAV 11. SETBACKS(ACTUAL) FRONT: / BACK: � RIGHT LEFT SIDE SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate oxes) �' ` ),3, a U 1 D. 40 NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ J INTERIOR RENOVATION RESIDENTIAL [ J COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 2S 091I1 4 iU•t't US 14. Sq. FtJCONSTRUCTION: �( % 'f5. Sq. Ft. 1 st Floor: 16. VALUE OF CONSTRUCTION: $ I5� The value of construction is used to determine the amount of permit fees to be assessed. SL 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 mlore, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 OWNER INFORMATION: -9-A Amt1109.4 [I'/r/��7t�t'j ADDRESS: ski/ A .. $ IN CITY: STATE: .CGS ZIP PHONE (DAYTIME):��L�' 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 INFORMATION /�J1 ST.ofFLREGJCERT#:e6U01rJ BUSINESS NAMEF�QWV QUALIFIERS NAME: k�'}�C/n� AOG c� ( ADDRESS: vV v L CITY: - - — - - - PHONE (DAYTIME): ARCHIT/ENGINEER: oL ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: ST. LUCIE COUNTY CERT #: 06 5cp__ ZIP Uat STATE: ZIP FAX NO.(aJ�(_ //��,, // ' STATE: ZIP 6eko-t-b 1SZ / 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. 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 1S 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 construcfiemand zoning. OWNER/CONTRACZ 1GNATURE v STATE OF FLObA COUNTY OF The foregoing trument was ackno�d W1oa thisLyday of 200 by ,who rsonally 1 nown to me or O ced as identification. J � ignature of Notary Type or Print Name of Notary CONTRACTOR WISNATURE STATE OF FL�Y�IDA CO NTY OF 444AM The foregoing instrument w s acknowle�d fore a his —1 day of , 20t7� , by who is per onally kno, wn to r o has produced as identification. i Si nature of Notary Type of Print Name of Notary Notary Public Title Notary Public Title hb&04(W Commission Number Commission Number tee+" Patricia A Cordie (seal) ' My commission 00320448 (seal) �"Patricia A Cordie . a M1�e Expires June 14, 2008 gyp. MY Commi3eion.DD320448 of war Expires June 14, 2008 NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEE2BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.