HomeMy WebLinkAboutCertificate Of Capacity - Zoning ComplianceOFFICE USA ONLY:
DATE FILED:
PLAN REVIEW FEE: . O O RECEIPT NO.: l Z PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT, CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIO S DIVISIONi Virginia Avenue
Ft. . Pierce FL 34982-5652 6
772-462-1553
Ian d tr_) One
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANC
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS.
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary): ?i v a.- rNA— to l . -
04- +V-geA- 1A M 1' omb.d K6 71,-e 11L-T o S.D.I
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
10. COMPIATE DESCRIPTION OF
e1 DCeit roc
PROJECT OR WORK ACTIVITY:
P4)nYoDw.s id A<2W)
11. SETBACKS (ACTUAL) FRONT: BACK: --IGHT SIDE: 'EFT SIDE:
12 TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION
RESIDENTIAL [ ] COMMERCIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
INTERIOR RENOVATION
INDUSTRIAL
14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $ la`, DOD .
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 valuc is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
i 1
UPDATED 6/25/09
i
OWNER -INFORMATION
NAME: cS - \e 'Reh1-47 Gy.61
ADDRESS: tA 6 ,: jy\Avi h2y', 3
CITY: 7 w P A C" STATE: IK ZIP: -53 K
PHONE (DAYTIME): (__) 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:
PHONE (DAYTIME): U
STATE: ZIP:
CONTRACTOR INFORMATION.
c.
ST. of FL REG. CERT #: ST. LUCIE COUNTY CERT #:
BUSINESS NAME: )-\e ob 4 p-
QUALIFIERS NAME: li'yc 1c"o me,' I a Cl
ADDRESS: (3 1) D `k eovg , '}",cJ
CITY: v 1 k'e STATE: ZIP: 3 c/ 9 S-C>
PHONE (DAYTIME): y) LJ 13' 61 c/'7 FAX NO. Email:
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE: ZIP:
STATE: ZIP:
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.
a
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 structure
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.
ER OR CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF S- L.u_u t,
The foregoing instrument was acknowledged before
me this day ofh )
0') 20 la --
by
who is personally known V or has produced
identification.
4ZONTIRACTOR SIGNATURE
STATE OF FLORIDA f
COUNTY OF
The foregoing instrument was acknowledged before
me this 9b day of AI&V , 20—Lao
by l [ l&r /V C/w l
who is personally known IX or has produced
Wnatur&T otfiry r atureofN rye ll//
Nancy L. Hamil Commission
No. GG(iJ O ($ COMt1iSSI0N#
EE035845 Commission No. noY L• Hamilton T.19,2014 :r"gar°'r C W.
EXP;REs..00 -- rc=; n:OpMMISSION#EE035845 wwwAARGIANOTARY.
com y"'. `
EXPIRES: OCT. 19,2014 Q
W , WWAARONNOTARYAOM 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 OFFICE LISTED ON THE' FRONT OF THIS APPLICATION. OWNER
BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS. ' For
specific in' tructions see appropriate permit 'hecklist.
OFFICE USE ONLY BP #:jjki - '2
SECTION Z TOWNSHIP
UV
RANGE 40 MAP NO.
ZONING LAND USE C LOT CVG %. TAZ NO.
FLOOD ZONE FIRM MAP # I ST FLR ELV MAX HGT
CONST TYPE OCCUP TYPE MAX OCCUP OF FLRS
WATER SEWER SPRINKLERS STORMWATER
LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT
Before 111990 After 1/1990 REQUIRED APPROVED
REPORT HABITABLE RADON PERMIT
CODE' y AREA FEE FEE
RADON)
LIBRARY PUBLIC BLD PUBIC BLD PARKS
IMPACT IMPACT FEE IMPACT IMPACT
FEE CORRECTION 4NERAL FEE
SCHOOL ROAD CREDIT Y N LAW ENF
IMPACT IMPAC IMPACT
FEE FEE
FIRE/EMS DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE
IMPACT REQUIRED FEE VARIANCE FEE
FEE
SPECIFY MECHANIC ROOF NON -CONFORMING MISCELLANEOUS
SUBS ELECTRIC GAS LOT OF RECORD FEES
REQUIRED PLUMBING FEES
DATE SENT TO ADDRESSING:/