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HomeMy WebLinkAbout1002-0106 APPLICATIION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY_ 1 OFFICE USE ONL :: SCNN hU DATE FILED. ovv�- q I 1 D PLAN REVIEW FEE: �D'at� RECEIPT NO . PERMIT NUMBER: /�I d + i CONCURRENCY FEE: RECEIPT OPMCI U1 YteCERT. CAP. NO.: ALL INFO MUST BE COMPLET �JG` COG St. Lucie County 2300 Vi .'O�OR10 Ft. Pierce, APPLICATION for CERTIFICATE of CAPACI & FILLED IN TO BE ACCEPTED iilding and Zoning is Avenue 34982-5652 -1553 µ. /ZONING COMPLIANCE PRO CT INFORMATION 1. LOCATION/SITE ADDRESS: ® N. w 2 _-V& tii 2. PROJECT NAME: / v a y / E 5 :El ITE PLAN NAME: 3. PROPERTY TAX ID #: 5702 ` , b I - l a. 56, 5 I 4. LEGAL DESCRIPTION (attach extra sheets if necessary):' I 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO.0 _ C7 8. LOT NO. (06 .I 9. PARCEL SIZE (ACRES/SQ FT.): LOT DMMNSIONS: _ 39' t6 I I 10. COMPLETE DESCRIPTION OF COCCNSTRUCTION PROJECT OR WORK ACTIVITY: 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL ! [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 14. SQ. FT OF CONSTRUCTION: I o k D 15. SF. FT 1st FLOOR: 16. VALUE OF CONSTRUCTION: $ 1 1-► py �I lS, w rr ` ope 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 $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 I OWNER INFORMATION NAME: OL \A- e,,1 L' U s ' ADDRESS: e ke- V I. �1 [3 r� CITY: -'.c? �A �'�l c r-� STATE: �- ZIP: � I T 5 ,/ PHONE (DAYTIME): (S �� I i+ Email: ©V1 , i 0. C C. / cv o"�'I h Zt i I _ C a" IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER)I IS D NT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STAJWJ PHONE (DAYTEAE): V CONTRACTOR INFORMATION ST. of FL REG.CERT #: 'UQ� -03 3 ,2'L- BUSINESS NAME: z eS ol•%$ QUALIFIERScN,AME: , I L ADDRES,S%• d 0 ! 5 CITY: H" tok e SSo(/,0d STATE: PHONE (DAYTIME): Vb �&�' _ FAX NO. ARCHIT/ENGINEER: DZS .nV�rb�rner a, ------ an— L-�a l— %J 11 1 A IST. LUCIE COUNTY CERT #: STATE:L. PHONE (DAYTIME).- %) I BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: Email: ZIP: J 5jvJ-f— IWORTANT 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, 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. OWNER OR CONTRACTOR IGN CONTRACTOR SIGNATUfiyZ STATE OF FLORIDA _ STATE OF FLORIDA�h� COUNTY OFCOUNTY OFcJ The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this :5# day e.& � , 20 / 0 , me this e— m day of , 20 16, by 1 a_emn /.e /1es by . who is personally (mown or has produced who is personally known P or has produced as identification. as identification. Signature of Notary . �� *�•: Notary Public �� �,y •;My Commission Expires Jul 28, 2010 Commission No. (Seal �±,��F� ��,,' Commisslon�an N . (Seal) "�� Bonded By National Notary Assn. 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 OWNER/BUILDER APPLICANTS. I For specific instructions see appropriate permit cheddist.