HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYI L
PLAN RE W FEE: RECEIPT NO.1.3d- + b PERMIT NUMBER: JaQ f 0 o SW.
_
CON CY 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
• FL I a SCANNED Ft. Pierce, FL 34992-5652
BY 772-462-1553
St. Lucie Cou*
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
c
I. LOC TION/SITE ADDRESS: I \ � • / J
2. PRO CT NAME: y "4 t` ! 1hS SITE PLAN NAME:
3. PRO RTY TAX ID #: d irk b S 6 5p o d U l-1 ( d 0 O 9
4. LEGL DESCRIPTION (attach extra sheets if necessary):
5. PLAT
BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
Z o
9. PAR
L SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
i0. CO
LETE DESCRIPTION OF CONSTRUC ON P O T OR WORK AC Tc
:Vet
, v; .e. o �r V-1 C-
r t tP Os
l il. sETB CKS (ACTUAL) FRONT: `� ,63 BACK: -9740 RIGHT SIDE: 30 , G d LEFT -SIDE: 3 ,0'0.
i2. TYPE ,
F CONSTRUCTION (Check all appropriate boxes .
[ ]11 EW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ]I SIDENTIAL [ ] CO�RClAL \ [ ] INDUSTRIAL
S
[ ] R (SPECIFY) t� c� V-!�t
13. DESC TION OF PROPOSED USE: 7Z> 4 oy-0\5 ✓
14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR:
GG ""
16. VALU OF CONSTRUCTION: $ L on 0
Tlic value of co 'on 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 constructioi if it is demonstrated that the submitted figures are not consistent with similar types of constmetion activities. If the value is $2500 or more, a
RECORDED Notied ofCommencement must be submitted with ibis application
SLCCDV Form No.: 001-02
�S `1 UPDATM 6n5ro9
OWNER INFORMATION
NAME: J e r v- I
ADDRESS: �� !i1 GI Gl
CITY: (� t rGl" C Q STATE: T ( ZIP:
PHONE (DAYTIME): (i7J) S 7 — SQ Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTM): �)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
ST. LUCIE COUNTY CERT #:
r
.
CITY:
i
STATE: ZIP:
PHONE (DAYTIME):
FAX NO. Email:
.I
ARCHIT/BNGINEER:
ADDRESS:
CITY:
STATE: ZIP:
PHONE (DAYTEVIE): ( )
t.
i.
BONDING COMPANY:
ADDRESS:
CITY:
STATE: ZIP:
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: ZIP:
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
cL` wjr
This appliew
if applicable;
work=will be
.may be requ
AND AIR C
!St. Lucie Co
which is in i
structure. PI,
The followir
structures (a:
Tesidential us
NOTICE T(
NOTICE
'CATION:
n is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
Jr the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
rrformed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
ad for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
NDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
ity makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
allict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
se consult with your Homeowner's Association and review your deed for any restrictions which may apply.
building permit applications are exempt from undergoing a full -concurrency review: room additions, accessory
types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non -
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.
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.
OWNER COCTOR SIGNATURE
STATE OFF ORID1�, /
COUNTY OF' 5 '1'.`G
The foregoing ' strument was acknowledged before
me this day of G h 20 ,
by
who Aerso
y known
FL
Signature of P Otary
Commission 1i o.
or has produced
identification.
--T DAWN Mlles
s3M4 t to 92W
RFC V!%WIN .Z M113
�Btthb9d flsilt�t ttic7&�f7'�4>at� r,t�atl1ECPISst�rS
m
r
C7LL) t1 ' r
STATE OF FLORIDA J 14-11-9
COUNTY OF _ <.
The foregoing instrument was acknowledged before
me this day of 20�
by11,
who is rsona known or has produced
L I) L as identification.
rgna re of Notary
p�-p,A/6-1�_ -
ppY Pint. - DAM MILONE
Commission No. MY 4910OWN n 00 662597
z3'• = F7tPOE5 Mardi. 22, 2013
bkor) That) P1ot#ry Pabfio Un ters
NOTE: TWO 2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS'UILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS PLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
O R BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERIBUILDER APPLICANTS.
i
For specF instructions see appropriate permit checklist.
OFFICE USE ONLY #:
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE.
FIRM MAP #
IsT FIR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FIRS
i
WATER
R
SPRINKLERS
STORMWATER
I•
I
LOT OF REC
Before 1/1990
LOT OF REC
After 1/199.0
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
Ih
1
P BLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
I
II
SCHOOL
IMPACT
FEE
-
ROAD
FEE CT
CREDIT
Y
N
_.IMPACT
LAW ENF
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
I
j
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF
ELECTRIC GAS .
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
'-
DATE SENT TO ADDRESSING: ! /
I�
i
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW.
SEA TURTLE
REVIEW
I (MANGROVE
I REVIEW
DATE.
RECEIVED
-
DATE
COMPLETED.
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INTfIALS
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