HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYIII
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�OFF ICEUSE
ONLY: SCANNED
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13 FILED: VE-:
REVIEW RECEI•f1,��f ' r PERMIT NUMBER:
CERT. CAP, NO.:
CON
URRENCY FEE: RECEIP NO.:
ALL INFO MUST DE COMPLETE & FILLED IN TO DE ACCEPTED
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
' BUILDING & CODE REGULATIONS DIVISION
Y
_ 2300 Virginia Avenue
° Ft. Pierce, FL 34982-5652M. I J
772-462-1553 �w
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1
APPLICATION for BUILDING PERMIT
CERTIFICATE ®f CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
i
-
2.
PROJECT NAME SITE PLAN"NA`ME: ` — - — -- — --
3,
I
PROPERTY TAX ID #:-1'SOZ'" 50 " D
4.
EGAL DESCRIPTION attach extra. sheets if ecessar 2 G1.
' 3 o-rah-w r� C or+-,•►-, orJ
5,
PLAT BOOK �' c 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9,
PARCEL SIZE (ACRES/SQ FT.): O LOT DIMENSIONS:
1.0"
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
V-%grMA ZV 13
11.
SETBACKS (ACTUAL) FRONT: U; BACK: RIGHT SIDE: LEFT SID
12.11
TYPE OF CONSTRUCTION (Check all appropriate boxes) -7
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13.
DESCRIPTION OF PROPOSED USE:
SQ, FT OF CONSTRUCTION: GbD 15. SR FT 1 st FLOOR:
^ Ov
VALUE OF CONSTRUCTION: $ O�
il
[RE(
v ahte 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
of construction ifitis demonstrated that the submitted figures are not consistent with similar types of construction activities. if the vahre is $2500 or more, a
RDEDNoticeof Commencementnrustbesubmittedwiththisapplication.
I CDV Form No.: 001-02
UPDATED 6125109
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I'N R 1INFf'®RIiF91ATOOK
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ADDRESS:
CIT
STATE: ZIP:
PHO'I
(DAYTIME): (O `i Email:
IF T
1. FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
i
FIL
IN NAME AND ADDRESS BELOW.
FEE
SIMPLE TITLEHOLDER:
ADjL
SS:
CIT
: STATE: ZIP:
PHO
i E (DAYTIME):
CO
"TRACTOR RMFORMATION
ST.
If FL REG.CERT #Z. ST. LUCIE COUNTY CERT
BUS
: SS NAME: o rY1 5 a r
I',71ERS
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NAME:
AD
;MESS:
CIT
, 0 STATE: ZIP:
PHO
: �� ��.rd�FAX NO. pADO Email:
p� 3
(DAYTIME}to
a
AR
IIIMT/ENGINEER:
_
ADI
CIT
TRESS:
: STATE: ZIP:
PHC
E (DAYTIME): C___)
BO
ING COMPANY: �^ -
ADI
RESS:
CIT
: STATE: ZIP:
'll
MORTGAGE
LENDER:
ADI
RESS: A
CIT
: STATE: ZIP:
4
ORTANT lYOTICE> When a pe>rnAt is issued and it is not picked yap within 60 day after notification
t
it m
III be voided and returned to you by nmaillo
,4 4 t
This
pplication is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if ap
licable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
wor
will be performed to -meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may
e required for. ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, BEATERS, TANKS,
AND
AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building pen -nit application.
St. L
cie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
whic
is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
struc
11re. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The
ollowing building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
struc
res (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
`resid
ntial use.
NOI
IICE 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.
NO
IC' TO �.�P) I�ANT:� IIFwITTS VOT O�JR GHT TITLE; AND INTERES I �THA IS.; IIBJEC O---- -- , �_ m
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.
I .
0
ER OR CONT CTOR SIGNATURE ONTRACTO NATURE
STA
E OF FL RID STATE OF O ,�A
CO
TY OF--irL_ COUNTY O mac.
The
oregoing instrument was acknowledged before The foregoing instrument was acknowledged before
met
is 10 day of 20 3 me this `p day of 20 ( 3 ,
by
I� V l S �`(.(i'�� Q � by � Gil 6Cr-,dL.l
who
personally known or has produced who is personally known or has produced
lis
as iden ' cation. as identification.
_ Signat e4Nry
sign!'
Colt!S6aRf
Vp;,�
° �P P)CY MINI$ ARM,9TRp.W9)_. Commission No. (Seal)
q
' , y A9852 rl}V"�4�,
. XRinS January a�, 2015 NANCY MIME r^:, j,;>"PRONG
407 393.0733 n
F1064ON01a 9®rvlee,00m %69 MY COMMISS =.; ;:; i.E059652
NOTE:
TWO SIGNATURES ARE R UIRED. EACH S. I RZ";—N <'4I f Y9 IF APPLYING F®IS
(2) a
THIS BUILDING PERMIT AS AN OWNER/BUILD ° i ER.MEI 4T'sl E'..WNAL Y APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS AP�'YC
OWNER BUILDER AFFIIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. '
!
Foil,,
ns See appropriate ' eI°mit 1 heci�l ist.
specific Illt5itlri.IlcC�.®permit � ! I
III