HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYi. -
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EVIEW FEE: RECEIPT NO.: PERMIT NUMBER: 13 i a� 401
RRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2Pie ' Virginia Avenue _ 00Q i
" Ft. Pierce, FL 34982-5652 � ri3� Z '�
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: i Q1 g Q(,eo(,C)r. 3 CM(% BfCkCh FL SLN5-
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID# 145/1-1516- d0'IZ,- 06Q -3
4. LEGAL DESCRIPTION (attach extra sheets if necessary):ytrh tU IfL ()u + a4 1 ^d i a, 126e Gr. 1 UL.
5. I PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
a cj�
9. PARCEL SIZE (ACRES/SQ FT.): 1A '10 LOT DIMENSIONS: ;�-- �S J4 4,�
10. I COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 9 Moll pl [I
11. 1 SETBACKS (ACTUAL) FRONT: BACK: �� RIGHT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
LEFT SIDE:
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
V
SQ. FT OF CONSTRUCTION: �> 15. SF. FT Ist FLOOR:
VALUE OF CONSTRUCTION: $ / qv " 'o O�
The vLie-
oftion 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
valueonstruction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECOED Notice of Commencement must be submitted with this application.
Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION
NAME'
# V,.►a I (I OjNd 1V Q n C 16LIrtC
ADD SS: I O O 1 S. Oman De.
CITY: STATE: L ZIP: 3y Q 5 -1
PHONE (DAYTIME): (865) 33$ - 047 "1 Email:
IF TIE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
CITY:
(DAYTIME): (_ )
STATE: ZIP:
CO `TRACTOR INFORMATION
ST. of L REG.CERT #: 05q y 12. ST. LUCIE COUNTY CERT #: 2 3 (, 3 O
BUS �SS NAME: Mic (-
OUA I FIERS NAME: 1-)-2 ss�e
ADD LESS:
CITY: �iC S`��� 4i e, STATE: 7—' ZIP: S,f
PHON�I (DAYTIME): _) 7? ` / FAXNO. Emailln�)�.jc�a'y! Z` ycC�
ARC T/ENGINEER:
ADDASS: SS: � .� JeL; 3 W
CITY: S�V)qr- STATE: +�� ZIP:
PHO (DAYTIME):
BONING COMPANY:
ADD SS:
CITY:
MOR 'GAGE LENDER
ADD SS:
CITY:',
STATE: ZIP:
STATE: ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it wil be voided and returned to you by mail.
n
CERTIFICATION:
TIFICATION:
This a } lication is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if appli able, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work mill 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 A IR 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
struc ;e. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The fo lowing building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structues (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residemial 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 WITHYOUR
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.
(-` - -' r v
OWN I R Ok CONTRACTOR SIGNATURE
STAT ZK OF FLORIDA , `
COUPTY OF ��
The f ,regoing instrument was acknowledged before
me th'� day of 20_13_,
by 1 1 LkC,11%, II U
who h personally know -J or has produced
fN as identification.
of Notary V
•� ':"
3n No.
DAVID N. KNEPPER
Com 9 #DD 995518
.€
Expires September 25, 2014
%'I¢,pd 091
Bonded 7FwTroyFain lnwrance8OW85.7019
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this day ofbPC, , 20)'r?,
by W)GC'�. 'C61D,Z�S
who is personally known or has produced
Signature of
Commission No.
as identification.
DAVID N. KNEPPER
Commis�ppD 995518
��: pines bR ber 25, 2014
°+�,S_4h°•` Bonded TftTroy Fain lnswanca900,985.7019
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.