HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY-ZONING-4CANNED
DATE IL);D:
PLAN VIEW FEE: a SE i O�ia sr; Z�/ PERMIT NUMBER: I T%
,CONC RENCY FEE.o- .1?' . RECE T IVO.: 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 5652
v 1 t►—d�G- � 772-462-15531553
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APPL CATION for LD IT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1.
LOCATION/SITE ADE
2.
PROJECT NAME:
3. ,
PROPERTY TAX ID #:
4.1
LEGAL DESCRIPTIOT
kj
12.
13.
14.
a ` $ I PROJECT INFORMATION
SITE PLAN NAME:
1-fyyy'� 3
extra sheets if necessary):
_l
PLAT BOOK �' 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
110,622 •1 -qct I
PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
COMPLETE DESCRIIPPTION OF CONSTRUCTION PROJECT OR WORK CTIVITY:
SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: _;en 2_ LEFT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
7NEW CONSTRUCTION [ ] EXPANSION/ADDITION
RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: l U aJ
16. VALUE OF CONSTRUCTION: $ L0l -
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
15. SF. FT I st FLOOR:
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
C ec.vrcA 15k "k c7
UPDATED 6/25/09
/L� v fll vy� 6�r 91 1 0 2-
OWNER INFORMATION
NAME: k1l r a ,Wffl
ADDRESS: 1 1 S 9,
CITY: `�� �y QSTATE: ZIP:
PHONE (DAYTIME): n 19 ca QZL I "[ - l Email: b lx 'wr.:�
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (___) Vx
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
r-- ST. LUCIE COUNTY CERT #: (,' x- 1 1
eIZ5 L 7- its
CITYTj �-D,!qjA tf ` L ,LLL(cr-- STATE:
PHONE (DAYTIME): TZA 362, '9 FAX NO.
ARCHIVENGINEER: `
ADDRESS: ! Ro°eG fe
CITY: , STATE:
PHONE (DAYTIME): ®cl
BONDING COMPANY:
ADDRESS:
z
PLEASE
ZIP:
Email: 10
67&13r��AV,= -
CITY: STATE: ZIP:
MORTGAGE LENDER: \4bR o)i
ADDRESS: (D --
CITY: �, STATE: ZIP: yZ !nz/
IMPORTANT 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.
rK
�M_
Clure.
'TIFICATION:
Tication is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
ifble, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
wbe performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
m,equired for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
ACONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
StCounty makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
win conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
stPlease consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The bllowing building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
stru 1,
ures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
resl ential use.
NO ICE 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.
I
N TICE 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.
I
SIGNATURE
TE OF Fl
JNTY OF
foregoing instrument was acknowledged before
his 30 day of 20 ( 1 ,
is personally known 4 or has produced
NOTARY PUBLIC -STATE 014LORIDA
'" Krystel Kamjj)
No.••' DD 33
mmiss;or. # EE 085 1
Expires: AUG. 05, 2012
BONDED THRU ATLA TIC BONDING CO., INC.
c�s a o� W , prt�
C NT CTOR SIGNAnRE
STATE OF FL�QRIDA
COUNTY OF �I (_1-1- U D
The foregoing instrument
1was acknowledged before
me this _day of Jam( , 20 (� ,
by JD Y- l (`�►rZ,�1�i�
who is personally known —4 or has produced
as identification.
Sig tur of Notary
NOTARY PUBLIC -STAVE 0F\ FLORIDA
Commission
Krystel Kami
�e 0o91
mmission EFO 85
%,�,,,° Expires: AUG. 05; 2012
BONDED THRU ATLANTIC BONDII G CO., INC.
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.
or specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP lim
- wpm
SECTION
1
TOWNSHIP
v5
RANGE
MAP NO.
2-B
ZONING
LAND USE 196-5
LOT CVVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1 65
I ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
�J
VF
WATER
^--
SEWER
SPRINKLERS
STORMWATER
3 jql
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
E t ! to "e
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
RADON
LIBRARY
IMPACT
PUBLIC BLD
IMPACT FEE
?
a�1- J3
PUBIC BLD
IMPACT
I—
l c6 -6�
PARKS
IMPACT
FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
t�
ROAD
CREDIT
Y
ON
LAW ENF
l �I•(I
IMPACT
�,3-1
IMPACT
f �4`J�
`
IMPACT
FEE
FEE
{
FEE
FIRE/EMS
5
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
VARIANCE FEE
IMPACT
REQUIRED
FEE
FEE
SPECIFY
MECHANIC ✓ ROOF ✓
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC �- GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING V
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
11v� 1)
�REVIEW
v /
DATE
�� (�
2-n I
f
COMPLETED
•c.
INITIALS