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HomeMy WebLinkAbout0804-0166 APPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY - ZONING._ QFFICE. USE: ONLY _.... . ..' . :..... . .: .... . � MAP NO. SECTION �] TOWNSHIP RANGE (� / ZONING LAND USE LOT CVG % TAZ NO. _a, _ia FLOOD ZONE FIRM MAP # /�� 1 FLR ELV 1 0 MAX HGT J LONSTTYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER - SPRINKLERS STORMWATER LOT OF REC (after LOT SPLIT LOT SPLIT LOT OF REC (before 1/90) 1/90) ED REQUIRED RED:....-:...:.... _ f -• - ADMINST LIBRARY ®p PARKS ICI-7' a� FEE PERMIT $ t'� -1 FEE VARIANCE IMPACT FEE IMPACT 015 D `b 1 HABITABLE RADON FEE REPORT PUBLIC BLDC CODE p IMPACT FEE i & a AREA (RADON) • SCHO OL GROSS ROAD CREDIT Y N TOTAL ROAD IMPACT FEE S I IMPACT FEE IMPACT FEE J DUE SCHOOL (� CREDIT Y N _4'_ � - �`�:�._':����-:;`- �;::. sYSCHOOL TOTAL ; ::::::..:,. 'x IMPACT FEE IMPACT FEE _-:;:,,.. ._•.:;... ,�.� POLICE FEE FIR MISC FEE TOTAL POLICE/FIRE LA10$ 5 ��y' MISCFEES N SPECIFY .TOTAL of AL"L ADDITION Y PERMIT FEES, RE D REVIEWS ZONING ZONING PLANS MISC. VEGETATION SEA TURTLE MANGROVE REVIEWED BY EXAMING DATE �r�86vJ �Y QifOI�JO� -'IcS�V� COMPLETE INITIALS DATE FILED: PLAN REVIEW FEE: r� . -0 RECEIPT NO.: /- PERMIT NUMBER: CONCURRENCY FEE: 24-: eO RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED St. Lucie County Building and Zoning • 2300 Virginia Avenue '`lORlO CANNED Ft. Pierce, FL 34982-5652 Cj�� BY 772-462-1553 St Lucie County APPLICATION for BUILDING PERMIT �J ►� CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: -7(,, ,Sq PER,10k,4 'PGe w`rm )�>f! tkS Ul en'�e-n 6 dGck .349.5-7 2. S/D NAME: PE4CA14 t-rM WiEP-6r SITE PLAN NAME: 3. PROPERTY TAX ID #: -3572Z A ICJ CPO OPQ 0 4. LEGAL DESCRIPTION (attach extra sheets if necessary): �L-� '� Vbi� wG;!5r P(3 4o `35) [5Z9 --L5" ZOLt — 1S TO 5. PLAT 6. PAGE 7. BLOCK 8. LOT BOOK NO. `� NO. . NO. -� 9. PARCEL SIZE: ACRES/SQ FT. Z� i 3 " LOT DIIv1ENSIONS �5 X ! 11139 - 5 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: R 11. SETBACKS (ACTUAL) FRONT:oggr' BACK: ,11-46 SIDE : �� SIDE. TO !o -'1C �.�. 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE:t-E 14. Sq. FUCONSTRUCTION: (044-4 15. Sq. Ft. 1st Floor: «JA 1-71 16. VALUE OF CONSTRUCTION: $ J4 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 CERTIFICATION: OWNER INFORMATION NAME: M �- to �� ADDRESS: 40277 MAO`Soks CITY: -STvA-7 . r STATE: -- ZIP JT�R PHONE (DAYTIIVIE): 1� ` . z M - QigbT email: 01A. IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME'AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: • `C'�� ADDRESS: CITY: PHONE (DAYTIME) : . STATE: M CONTRACTOR INFORMATION ST. of FL REG./CERT #: z� ©leg ST. LUCIE COUNTY CERT #: 1 BUSINESS NAME: t-QLAY'�LZ:4 """-' - QUALIFIERS NAME: ADDR.tSS: CITY: Pm -I" S Wi STATE: 1 — _ :ZIP. 'v FA7(- PHONE-(DAY-T-IME)--(--) Sfl-cstDSCL�ti�cTlpi� C.i�►Y� ARCHIT/ENGINEI✓R: ADDRESS: CITY: STATE: ��- .ZIP �- PHONE (DAYTEVM): BONDING COMPANY: o (A ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: ZIP A 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 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 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construe on and zoning. OWNR/CO RACTOR SIGNATURE CONTRACTOR SIGNATURE E STATE OF FLORIDA I STATE OF FLORIDA COUNTY OF IY �H - COUNTY OF , The foregoing ins ument as a�knowI d ed The foregoing instrument was acknowledged before me this `array of , 20 by before me this tay of , 20 L by - M0.Y11 01 1100 , w o person y f�= id, 4-VS ,who is personally_ known to me or who has produ known or who has produced as e 6 tion. A E DENEDIOS as identification. i\atii111ilPil := MY COMMISSION ! :i +jam EXPIRES•k- Bonin;" ..ade ��\S510N�,',,. Signature of Notary = 4ure of Notary �^ D 300112 ; o= o S r1 r v 1 ��y•.��a eonded�h0 or Print Name of Notary Type or Print Name of Notary %9ipUeUC 163 Commission No. �) 1�t�Nt1!S!<< 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. r. II For specific instructions see appropriate permit checklist.