HomeMy WebLinkAbout0710-0338 APPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYOFFICE USE ONLY
SECTION
TOWNSHIP
ZONING
LAND USE
FLOOD ZONE
FIRM MAP #
CONST TYPE
OCCUP TYPE
WATER
SEWER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
RANGE
LOT CVG %
1ST FLR ELV
MAX OCCUP
SPRINKLERS
LOT SPLIT
REQUIRED
BP #:
MAP NO.
TAZ NO.
MAX HGT
# OF FLRS
STORMWATER
LOT SPLIT
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BID
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
=
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES -
DATE SENT TO ADDRESSING: / I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
INITIALS _
'IF,ckus:dg,�.
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
A-LZ INFO -MUST -BE COMPLETES FILLED IN -TO BE ACCEPTED
v� St. Lucie County Building and Zoning
? 2300 Virginia Avenue
�flR1 -iere�-
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
SCANNED
PR JECT INFO TION BY
1. LOC
ATION/SITE DRESS: Q St. Lude COUP
2. PROJECT NAME: UkNJ h Ppull k4TTE LAN NAME:
3. PROPERTY TAX ID #: C2-:-z 1" » So 0. 00C -1 000.7
4. LEGAL DESCRIPTION (attach extra sh if necessary): CAV/U � b U 5 it 4U ' T O IV ^ "
Lei 7(ok
' (o.G A0Ig0q-Ij?q fI%oq-���/�G
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
10. COMPLETED SCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: Qdj s 1 P'o CT � L�
�
11. SETBACKS (ACTUAL) FRONT: 18 BACK: a�S RIGHT SIDE: LEFT SIDE: i r
12.�) TYP OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [I INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. C) DESCRIPTION OF PROPOSED USE: V L [y I C tx Nld4 wit A)
14.0 SQ. FT OF CONSTRUCTION: u U 15. SF. FT 1st FLOOR: Y U U
16. D VALUE OF CONSTRUCTION: $
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
OWNER NF,�npORMATIO VZ
NAME: b V S
ADDRES�{S- 1 `D
g-CITY:
PHONE (DAYTIME): (72�)
- )-& )' 6 Email:
-- -ZIP-: -- 3
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:
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: nQJ%�C7 ' ` 0
BUSINESS NAME:
V'QUALIFIERS NAME:
9 ADDRESS- � _X
PCITY:
PHONE (DAYTIME): (Z4
ARCHIT/ENGINEnER: L !V 13
ADDRES : ! q a1 ttoxn
CITY: M 0 S t 6 ni
PHONE (DAYTIME): ()
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
ST. LUCIE COUNTY CERT #: a1 d
zoo 0-1
STATE: 1
STATE:
STATE:
ZIP:
ZIP:
RM
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.
CERTIFICATION:
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 applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will 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 AIR CONDITIONERS, 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
:stru_c-_ture. -Please consult-with=your Homeowner's Association_and.review your deed_for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
wi all applicable laws regulating construction and zo
OWNER OR CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLORID,9
COUNTY OF
The -foregoing instrument was acknowledged before
me this day of 20-04?*-,
by�ppT �•
STATE OF FLO
COUNTY OF M
The foregoing instrument was acknowledged before
me this day of J' 2®j
by
who is personally known or ha produced who is personally known or has produced
6 - � &4i p� • �i-C
as identification. • w ' as identification.
Signature of o ary Signature of try
Commission No UDREYB•611iQ�3147 Commission-�ktIBREYB H MPH EY
=q' MY COMMISSIO a4
* Liters
My EXPIRES: March 6 c-rs .o*` DD 63304?
°' N Notary Public Undern' p` EXPIRES: March 6, 2011
�•o�' Bonded 7h '%;;p�,•` Bonded Thni Nota Public %F, oc N Underwriters
NOTE: TWO (2 ATURES ARE REQUIRED. EACH SIGNATURE MUST BE N G 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.
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