HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYI
OFFICE
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PLAN R
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ONLY
BY
W FEE: RECEIPT NO.:
1CY FEE: RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce„FL 34982-5652
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
c / PROJECT T INFORMATIONLOCATION/SITE ADDRESS: O'9IO NJ Q iGt (2S �jl `/ OL
PROJECT NAME: 1 ' SITE PLAN NAME:
PROPERTY TAX, ID #: I- 5D Z' -4�f - I O� Ci- oan -3
Ly�A� DESCRIPTION (attach extra sheets if necessarfl YI):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO.
9. PARCEL SIZE (ACRES/SQ FT.): , O ' LOT DIMENSIONS: _
10. I,j COMPLETE DESCRIPTION OF
OR WORK ACTIVITY:
8. LOT NO.
oZ
11. ! SETBACKS (ACTUAL) FRONT: t BACK: RIGHT SIDE: LEFT SIDE:
12. ' TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [) INDUSTRIAL
[] OTHER (SPECIFY)
1331 DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: 15. SF. FT 1 st FLOOR:
VALUE OF CONSTRUCTION: $
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
e 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
:ORDED Notice of Commencement must be submitted with this application.
CCDV Form No.: 001-02
7'Y�ATED 125/09
u�—toe) r—�
OWNER INFORMATION
NAME: N
ADDRESS: ' (.0 V
CITY: STATE: ZIP:
PHONE ((DAYTIME): C___) Email:
IF THE �EE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL INI�,NAME AND ADDRESS BEL
FEE SI PLE TITLEHOLDER:
�I
ADD SS:
CITY: ++I STATE: ZIP:
PHON) ((DAYTIME): L—)
CONTRACTOR INFORMATION
ST. of
BUS
QUA I�IERS
ADDRESS:.
L REG.CERT #:
SS NAME:
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�,o N" 5
LA ) ST. LUCIE COUNTY CERT #:
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NAME:: {,V a L
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CITYi1 k,
PHO ! (DAYTIME):
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A D"L71TfCATl171.TCC0.
p STATE: el
0 p'JL/Ve FAX NO.
ZIP:
Email:
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STATE: ZIP:
E (DAYTIME): (_)
ING COMPANY: �j
ESS:
STATE: ZIP:
MOITGAGE LENDER:
/1/ I
ADDRESS:
CI STATE: ZIP:
�I
PORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it w;�ill be voided and returned to you by mail.
CERTIFICATION:
This appli�Iation is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applica le, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will1be 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 foll wing 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-
resident'al use.
NOTICfI 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.
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.
•11
TUBE
STATE OF FLORIDA
COUNTY OF
The'foregoing instrument.was acknowledged before
me II is V day of 20
by 6I 1 o Wk 0-5
wh I is personally known or has produced
T i6CD L n as identification.
NANCY MIMS ARMSfiKUNI---
MY COMMISSION # EE059652
FXPIRESJanuary JOM)5
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this / day o 20 �5 ,
by om aS /r7 i u »cCz.e
who is personally known or has produced
fft✓ /1 as identification.
^^TRONG
:*.' P�nY f;l}1n,f•; SL;r'(Seal�,d�',652
153
E: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUILDER, 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 OWNERIBUILDER APPLICANTS.
specific instructions see appropriate permit checklist.
II
OFFI lu E USE ONLY BP #:
II
SECTION INI
TOWNSHIP
RANGE
MAP NO.
ZONING 'I
LAND USE
LOT CVG %
TAZ NO.
�IIIIiII
FLOOD ZQNE
IIIII
FIRM MAP #
I ST FLR ELV
MAX HGT
I
CONST IT E
i
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER I
i
SEWER
SPRINKLERS
STORMWATER
LOT OF II C
Before I/1 90
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
lil
REPO R
CODE I
HABITABLE
AREA
(RADON)
RADON
FEE
PERMIT
FEE
I
LIB
IMPACT;
FEE I'I
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACj
FEE I,
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
I
FIREIE `I S
IMPAC
FEE !�
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPEC
SUBS
REQU D
,
MECHANIC ROOF
ELECTRIC GAS
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE
II
SENT TO ADDRESSING:
�I
RE HEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATF1!
RECE ED
DATq:l
COMPLETED
I
INITIALSI
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