HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY - ZONING:_4a•.}:::.}:: ;•;i:..:.;_:::. :r: x:}Y::.•.::f .. _..:•;,._.,:•ti..2}:-.-::,;,;:::.;N._±Y{±:r: r:.:`.;.i:{.. •.;;.};.::.:.l__.., i...:
_ - f
... ... .: ...n._v: ....C:..v v.. ......-v:i:::::.._:... i L� ::. n- •} .. ... :4:{r "?-:j�:+v±4irA: A.:.rhv :r•. x�rir.
... nv..: vv..{.... v v.... •:.+-.-......h n.. n...v :a:::n... ............. ..:. ...: •. ... Y... .. .. ..... ::. :. .:. jrvci'• �+}/ A?::•}];:t:•
_.... v.r.v..\... .h :-.2i ... ._.... ..}v4v..v... f. _.... ...++..+...... n..... ::. .:. ... +.
::.vi-:.:.f.•:v..�v:r•: :. .. .. :na... .r.._.._a.:.v...... w.._.... e..+.:: v:::.: vv. •. .. _.+. n.v C:. 4 -
..... ....... ..: _.:.:.. v_v.v\__..... ...n .._. .... r-n.. -v x .:::-: - .. .. .. .. .... ±}x}:nr.}nr: •v......
.v�_..r vnp :._._a: -`v».h4.:::=?:::: }:::rnv .�.v:}. :4::}'.-_.-_.:.v_{tv.: }v:-•1n v:.:vnX}: r. ±r •S-:. Yvf•:af..
.\h...v ...: v. .n ........ '-:..... _:.. .+. :. .. ±i.. -. .... nry n•.: X??
......+.+ . ... .hn:`.z..v.......avn}::--.::..:+.. ... .... .... ...•.:{.;-t'.:}y
-: -:ii:}
_ ..+:. .._:
.... ....:+_... .:-: :.�f... :.., :,.:.+,c._......... ...... ... . ... .:. ::...}:Lh .::n,
i•:m•r.. .... .•:: h
. fin: -.>.. .. r} . .+f.•.w A:X -:±�. -
.O ::.5}.}•.
.v .r.... x.:r... .. +...v a :: .:h r:. \. ......v... ... ... ..... .. n. n.. _.. .. .. rn. _. 9jvt:.v yr .
...++. r.
.... _A _..... .. .. :�+....-.:h _._. n ... .................. ...x ...RY n .x_--.v.n....r :w +-v..-:::.A f..::.n•:{�vv::___
.....#...+ :.... ++ M .......n..++......---- "--•-a---...+... n.V,..i:.v-{::.±±.r..:......-
{ a: vv\ h 1 i -•. f .v._.v:.v :.-a: .v .. }...... x.... ... ++.-.vn::+.n• r,-.v:d ::?x:: "?::r{:•;•..anv:±.
SECTION- I TOWNSHIP �� RANGE: ' MAP NO- . a,
ZONING:
-�
LAND USE:
n65
LOTCVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:.
61ST
FLR ELV:
HGT:
CST TYPE:
e>
OCCP TYPE:
MAX OCCP:
# OF FLRS:
- (G
WATER:
SEWER:
v
SPRINKLERS
STORMINATE
R
LOT OF REC (befr 1190)
LOT OF REC (aftr 1190)
LOT SPLIT
LOT SPLIT
REQ1)
APPRV'D
DECAL
LIBYq�PARKS
I
44�
PERMIT
NUMBER
IMPACT FEE _p
VIMPACT
FED
FEE.
I REPORT
CODE
1
PUBLIC BLDG
IMPACT FEE
21. 4 5
HABITABALE .
AREA
RADON FEE
f
(RADON)
ROAD
GROSS ROAD
1
CREDIT
Y
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
SCHOOL-
I.�
CREDIT
v }::: 's: r :r:,r ?:3
:> _;� ; r:
TOTAL
SCHOOL
IMPACT FEE
I
:,>•}.::;.r{:<, •., :^`":
s« .-:F„•_
'-t}-f:
IMPACT FEE
P E FEE
FIRE FEE
M1SC FEES:
TOTAL
POLICElFlRE/
MISC, FEES
Y
ADDITIONAL
SPECIFY:
��/j'V� Q�/'tJs
TOTAL ALL
PERMITS
FEES
REQ'D
i
REVIEWS
ZONING
ZONING .
PLANS
• VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
f o. to
COMPLETE
INITIALSP0
DATE FILED:
15LAN REVIEW FEE: TV RECEIPT NO.: c� � PERMIT NUMBER:
CONCURRENCY FEE: �'� 'b�- RECEIPT NO.: CERT. CAP. NO.:
ALLI F MUSTB ECOMPL -CO
MPLETE
u FILLEDIN TO BE AC
CEPTED
y
�v
_ G�6 co ST. LUCIE COUNTY PUBLIC WORKS ,_.
BUILDING & ZONING DEPARTMENT Vte 07% J (�(
2300 VIRGINIA AVENUE
420RtOa' FORT PIERCE, FL 34982-5652 � ���
i 772-462-1553�
1
64
tow
CtLPLICATION for BUILDING PERMIT— U �llm►�J
CERTIFICATE of CAPACITY/ZONING COMPL CE
P TcE Lei ,
P OJECT INFORMATION 3yelq U_
l CON OYD
1 _ LOCATION/SITE ADDRESS:
2_ S/D NAME: T SITEjPLAN NAME: I
3_ PROPERTY. TAX ID #:
4_ , LEGAL DESCRIPTION (attach extra sheets i necessary):
C,
5. PLAT. 6. PAGE- - 7_ BLOCK .8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS c� \ "� `
10. DESCRIPTION'OF CONSTRUCTION PROJECT OR WORK ACT ITY: Li
V .
11. S (E SETBACKS(ACTUAL) FRONT- ._ BACK: � ��� RIGHTLEFT ���
SIDE A;�''SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
4[NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL. [ ] COMMERCIAL ' [ ] INDUSTRIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. I MONSTRUCTION: 15. Sq. Ft.1st Floor.
16. VALUE OF CONSTRUCTION:
The value of construction is used to determine the amount of penT it fees to be assessed. St. Lucie County rese ves the right to question and/or modify tha
indicated value of construction-9 it Is demonstrated. that the subrratted figures are not coiVistent with sirrnTar types of construction activities. 0 the value is $25W
or more. a RECORDED Notice of Commencement must be submitted v►nh this application.
SLCCDV For NO--- 001-02
OWNER INFO
NAME:
ADDRESS:
CiTY:
PHONE (DAYTI
IF THE FEE Sib
BELOW.
FEE SIMPLE T
ADDRESS:
CITY:
PHONE(DAYT
ST. of FL REO
BUSINESS N,
QUALIFIERS
ADDRESS:
_______CITY: -
PHONE (DA)
ADDRESS:
CiTY:
PHONE (D)
BONDING C
ADDRESS:-
CITY -
MORTGAGE
ADDRESS:
CTTY:
iMPG
after
RATION:
• o )'� STATE: 21P Y
fti?�4�
TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
IE):
r• �t
STATE:
ZiP
S
STATE: 2(P
I
STATE: aP
i
.NOTI•CF: When a permit -f , issued and • it is not, picked up within 60' day�
tion it will be voided and returned to you 'by mail.
CERTiF
This application
capacity, if appro
and that all worl
separate permit"
TANKS, AND A
The following t:
structures (all t
residential use.
,TION.
is hereby made to obtain a permit to do the work and installations as indicated, and to c
Me, for the peftntited• work i certify that no work or installation has cornmenced prior to the
will be performed to meet the standards of all laws regulating construction in this jurisdictic
may be required for ELECTRICAL, PLUMBING, SiGNS, WELLS, POOLS, FURNACES, B
R CONDITIONERS, ETC., not otherwise -Included with this building permit application-
1 permit applications are exempt from undergoing a full concur envy review: room
swimming pools, fences, wails, signs, screen rooms, utility substations & accessory
in a certificate of
uance of a permit
1 understand that
ERS, HEATERS;
ors, accessory
to another non -
NOTICE TO 01 VNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT 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 A PLICANT: AS THE APPLICANT FOR THiS BUILDING PERMIT, IF iT iS NOT YOUR R HT T1TL .AND
INTEREST THAT iS"SUBJECT TO ATTACHMENT: AS A CONDITION OF T AIS PERMIT YOU
PROMISE INGOOD FAITH TODELIVERACOPY OFTHEATiACHEDCON 37RUCTIONLIEN
LAW NOTICE TO THE PERSON WHOSE PROPERTY iS SUBJECT TO AT rACHMENT.
OWNER'S AF DAVIT: 1 certify that all the foregoing information is accurate and that all work will be c one in compliance
with all applicable laws regulating construction and ing.
V
OWNER/CC OR SIGNATURE CONTRA TOR SIGNATURE
STATE OF I 10RIDA STATE OF FLQRI A .
COUNTY 01: COUNTY O .
d d
The
0
(seal)
NOTE: TWO
IF AP
TO S
�g rent was acknowledged The foregoing instrumerk►n(as�ackn a ge
its men
20� by _ before a this day of �, 20 by
i >so t f known o e who` a ono -
i as id 'on. or ho as produced en cation.
of Notary Sign of Notary
it Name of Notary Type of Print Name of Notary
ibliic Title _ Notary Pubriic- Title _
mimission Number' CommissionNumber
Kalhaleen A Powell
'�' ' yt Kaftlem A' 8
" ti fs
±= +�'!� CO!,04, SSM* DD140769 IXPiRES (S�) ,r .. 1=nMlS$tON# DDl 68 D(9fl2E$
October 24, M06 g October 24, 6
6Qt4�EDtF9tU7R0YFA91IRpNa;INC DeD7
.;P,a 500.HRU°7ROYFAIN pK _
�2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
'LYING FOR THIS BUILDING PERMIT AS AN OViiNEPJBUIL.DER, THE OWNER MUST PER ONALLY APPEAF
GN THIS APPLICATION IN THE OFFICE USTED ON THE FRONT OF THIS APPLICATION.