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HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY-ZONINGo _J o 0 000 • I. ' OT OF REC t LOT 0 RLOT 0APPROVED o t � SPLIT y ^.•R'*"ft 3Y'J +?pC�c�r t��{�N�G?iP�' �.1= $_:.fr'�s"_i8r �I::iv�..k_.:._.:'..a._-_.Y... �+. 'c5s� � u'E� N.S�'• �1 r ) 5 4 ��1.`F�.�ir 1 _ 23 .'Y ay v, ti 3'fi` h J .1�.' l r `j-a• 4..-Si�"C't ? - :,i .5• Y i Z G �r �i�'�"�. Kk�''�i' �Y. ! 11 � .,..y .0 �"'i5 .lt'h.Ch tL ..ltl-r•�,1Y�:.f�_ �.ir.. 3._:.Y .. A -.a., 3� f _ __..—._=c+J_^.u+t:�.__`/?_ l _ .G".Y.{ s '. �'X}�• *tom 't" �4_. 5•. "a_-. .• VARIANCE ...t t� .•.PUBLIC o�IMPACT BLD FEE HABITABLE�o AREA .D• SCHOOL. 0=�--TOTALROJ �SCHOOL TOTAL IMPACT FEE ftiY STD."fL`fti ; i ,�2-ry��,�'•y1v'\.?4".�y L� • • i:l-i+A ., �'Ie[^' �3 at - y,.z�T,�•tl°L 3 y.IMPACT FEE ,• • . POLICE/FIRE ��� ADDITIONAL Iv©. >� ij►1�J►1TOTAL PERMITS.REQUIRED FEES _ el ,4 r.��iK��1. �S Z. ��T.�,"ha• `y ..r.i.f.+ ee '%rmJi-4... l 4 G:. t, .'.s i •C'�a� �`e���T.. t.;:Y., J• � ;c�v,5,tr�'_ 1'. p...CiFs i .. 'fi:: •=:.... 1.�- c"'�'.:: �$� ��]�,.� 4 5 Y 1 0ZONING VEGETATI 0 MANGROVE REVIEWEDBY DATE FILED:a� - - PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: b c,g-- CONCURRENCY FEE: REC-EIP-T-NO.. ERT. CAP. NO.: ALL INFO MUST BE COMPLETE &_FILLED IN TO BE ACCEPTED St. -Lucie County Building and Zoning 2300 Virginia Avenue • F�RIOQ . Ft. Pierce FL' 34982-5652 SO 1. 2. 3. 4. APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION / LOCATION/SITE ADDRESS: L-� UU C) VAC, S/D NAME: (J,����{U ZITE PROPERTY TAX ID #: tCr5 C) LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT 6. PAGE 7. BLOCK BOOK NO. C NO. r S. LOT NO. 9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS ��3,VX I 3. 3 (o, X X31,' Y (lO, UCi � 1 ' 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: i LEFT: l 1. SETBACKS (ACTUAL) FRONT.BACIC: RIGHT: SIDE a t r f SIDE "1 ` :_f�� 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [✓]� RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 5_tarey CA c) S u e 14. Sq. FtJCONSTRUCTION: cl C 15. Sq. Ft. 1 st Floor: to G o 16. VALUE OF CONSTRUCTION: $ &A-P d0 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 INFORMATION NAME: JCX c- Q U t` ai S_ S ADDRESS: _ V- O i O L'r► ct_(• .CITY.: n�t - 5_ T.�c e STAYE: z1p 3 q q �5- a PHONE (DAYTIME): 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 (DAYTIME): ( U) S3(o •- !,a J q CONTRACTOR INFORMATION ; ST. of FL REGJCERT #: ST. LUCIE COUNTY CERT #: BUSINESS NAME: QUALIFIERS NAME: ADDRESS: `• CITY: PHONE (DAYTIME): (_) ARCHIT/ENGINEER: ADDRESS: . STATE: FAX NO. ZIP email: CITY::. ;. STATE: ZIP PHONE (DAYTIME): U 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. 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 corpmenced 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. The -following building permit applications are exempt from undergoing a full conchrrency 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 with all applicable laws regulating construction and zoning. < 4 J J-,, OWNE CTOR SIGNATURE STATE OF FL A COUNTY OF The foregoing instrument acknowledgedw�p� before m this of aKJ' J , 20by lZ who is per orally o to meZ�A pr - r entifrcation.�"g`rr,,�Q, i gnre at of to Co SIGNATURE STATIF FLORIDA COUN1W OF The foregoXig instrument was -acknowledged before me tlr _ day of , 20_, by who is personally known to me o who has produced as identification. Signature of Notary Type or Print Name o otary p�y� i Type or Print Name of No ary �T T . U'•.•/ ar _ Commission No.,. (Seal) Commission No_ NOTE: TWO (2) SIGNATURES ARE REQUMED., EACH SIGNATURE MUST BE NOTARIZED. THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY THIS APPLICATION IN.THE OFFICE LISTED ON THE FRONT OF THE APPLICATION. For specific instruction's see appropriate permit checklist. _(Seal) APPLYING FOR ?PEAR TO SIGN