HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYl
OFFI'�'E USE;ONLV- BY
DAT! FILEDt ude count/
PLAN REVIEW FE `3� O, 0 d RECEIPT NO.: � 30�( �i PERMIT NUMBER: 130 ro - O l
CON I URRENCY FEE: RECEIPT NO.: 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 r
772-462-1553 c�— ,-n-
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATIQN
o
1. LOCATION/SITE ADDRESS: I07oZS -T. 6 eWA) 1) ie. , --r--Js0V 1564-&I� FL- 3WCI
2. PROJECT NAME: ?Ue0I0y SITE PLAN NAME:
3. PROPERTY TAX ID #: �}$/% -5oi - oa73 - O� - 3 • .
4. LEGAL DESCRIPTION (attach extra sheets if necessary): }}&1 AV 6u "r 07: LUCIE j pTlO
1 Az S. Qurt•1 PQo_RAm �Nm/165Tj lei comma,✓ f-t ameat 33 0 497)
5. PLAT BOOK -q-q4f 6. PAGE 'airy O. �09 444 7 7. BLOCK NO. 1 8. LOT NO.0
9. PARCEL SIZE (ACRES/SQ FT.): . D LOTDIMENSIONS:
10. COMPLETE DESCRIPTION OF C NSTRUCTION PROJECTOR WORK ACTIVITY: t j
11. SETBACKS (ACTUAL) FRONT:_ BACK: RIGHT SIDE: _ LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes) V
[Vj'NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: S/a��E F�m i �U '2C-':5r/MA'c&
14. SQ. FT OF CONSTRUCTION: 1 -( f/3 15. SF. FT 1 st FLOOR: V 61.E
16. VALUE OF CONSTRUCTION: $ ! QaO •oo
The valu ' 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.
Form No.: 001-02
T 0
UPDATED 6/25/09
OW ER INFORMATION
NAM I . Pawl �. �►-�1 L. Rit/i.D��1
ADDRESS: �7eiS S: DC�/ a'P.
CITY:'STATE: ZIP:
PHO (DAYTIME): 7 1y • Sou Email: gegM PUi?P o1XJj(!t- IMAM. CNN
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL NAME AND ADDRESS BELOW.
FEE SAMPLE TITLEHOLDER:
CO
ST. c
CITY:
(DAYTIME): C__)
RACTOR INFORMATION
REG.CERT #:
S NAME:
ERS NAME:
(DAYTIME): L_)
/LNU1NEEx: n ttA
SS: %LOS"1;1J5L 69
(DAYTIME): c 444_S
COMPANY:
LENDER:
STATE:
ST. LUCIE COUNTY CERT #:
ZIP:
STATE: ZIP:
FAX NO. Email:
STATE: jcL ZIP: 3 S( d SZ
STATE:
ZIP:
CITY: STATE: ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it wile be voided and returned to you by mail.
i
CF�RTIFICATION:
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 app icable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work! Nill be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may a 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. L cie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
whicf is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
stru4 ire. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The llowing building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
struct ii es (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
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.
OR
SIGNATURE
STATE OF FLORIDA STATE O
COUNTY OF COUNTY
The
met
by _
egoing instrument was acknowledged before
)11N��day of J: Z Tyk- 20 13 ,
4uca�
who io, personally known or has produced
as identification.
SIGNATURE
The foregoing inst%0meme this da
by
who is personally known
NNA GIVENS
of Notary ,.�;Y'P�a,,,
Say. ��.; Notary Public - State o1 flo10d16I
:�. • ,`; pqy Comm. Expires Dec 16,
3n No. �5�1 �1l Commission # EE 656161
i
''••. ,gg! ;°P ` Bonded n ough National Navy Assn.
of Notary
on No.
was acknowledged before
20 ,
has produced
identification.
(Seal)
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.
For "specific instructions see appropriate permit checklist.