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HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITYI ZONING '� j l I LAND USE IT r-1) I LOT CVG % FLOOD ZONE I Y I FIRM MAP # t2"7rj I In FLR ELV CONST TYPE V 5 OCCUP TYPE �� MAX OCCUP WATER r .` SEWER SPRINKLERS LOT OF REC LOT OF REC (after LOT SPLIT (before 1/90) 1/90) REQUIRED ADMINST LIBRARY ���E =IM=PACT VARIANCE IMPACT FEE REPORT PUBLIC BID I. C>2-uo HABITABLE CODE IMPACT FEE AREA GROSS ROAD IMPFEEDU ;;;pI ° A-D 44 (RADON) CREDIT IMPACCT FEE SCHOOL IMPACT FEE P91'1C*E FEE Cf. �Q CREDIT Y N FIRE FEE MISC FEE Y MAX HGT # OF FLRS STORMWATER LOT SPLIT APPROVED PERMIT FEE RADON FEE TOTAL ROAD IMPACT FEE TOTAL SCHOOL IMPACT FEE POLICE/FIRE MISC FEES TOTAL of ALL FEES �twi - VEGETATION I SEA TURTLE I MANGROVE BY DATE FILED: �`' / f' `� U U' 10cwtV � rLAi�F R�v1£ _ �EFIl�T NOERNIIT NUMBER: CONCURRENCY FEE: S` II ZI-RECEIPT NO.: CERT. CAP. NO.: - AL= L- INFO-MUS-T BE CO- -M-P-LETE_& FILLED IN_ TO BE ACCEPTED _ St. Lucie. County Building and Zoning 2300 Virginia Avenue (i c' or 7 Et. Pierc-e,FL 34 -5652 t 112-412-1113 - — — � - k4 k or BT�ILTII ERMI r- 2le (.�P ICA `7� CERTIFICATE of CAPACITY/ZONING COMPLIANCE ,0 12 PROJECT INFORMATION E FF 1. LOCATION/SITE ADDRESS: Q SA-q A imjd4 2. S/D NAME: SITE PLAN NAME:le 3. PROPERTY TAX ID #: z- -zo1 " 111 cool — CDOO - 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT 6. PAGE 7. BLOCK 8. LOT BOOK —NO. �— NO. �� NO. • � LD 9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS q_1I• 1 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: - "ram �I, TEr 11. SETBACKS (ACTUAL) FRONT: „ _ BACK:. SIDE T: SIDE TYPE OF CONSTRUCTION (Check all appropriate boxes) [ NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) DESCRIPTION OF PROPOSED USE: `k� %v4*j }"NA'w Av 0A Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1st Floor: VALUE OF CONSTRUCTION: $ . UV 70 6 e 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 alue of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 CERTIFICATION: OWNER INFORMATION NAME: � F� E-X t>0�6� 4t �� ' t� tt ADDRESS: 01 s4c j 2?bw+,k- ,1 N CITY: r) `PYcd1t-t` AO►' JSTATE: ZIP - PHONE (DAYTIME): ( ) email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAMEAND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): (_J L CONTRACTOR INFORMATION�� ST. of FL REG./CERT #: cle-o' C 0'2'J S J Co ST. LUCIE COUNTY CERT #: BUSINESS NAME: \� hl &C_�%©►.x , % - QUALIFIERS NAME: ��� *,L`- ADDRESS: CITY: I�►1 ,i1 r STATE: ID P, ZIP 3�y PHONE (DAYTIME): ( neJ 17-0 , LPS51 FAX NO. _6Q15 -12®- (V5 email: �'� �"�' Ganl-aC�- Pessnn'U ��n ha Z0L4� pincane ��]� LJN - vL5.3,7 /�. - 32.bI ARCHIT/ENGINEtR: b > =�' k1 , 46U - Q 4 Q 7 ADDRESS: IS$-� P .vim �� SbU ►Ve 200 CITY: �A 14A` STATE: FLA30 0�' ZIP PHONE (DAYTIME): (A!O 2•`15 ' %0 N \'35 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. 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. 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 f9W90ing information is accurate and that all work will be done in compliance with all 2plic aws regulating construction and zoni ng. / .. v P­ O ONTRACTOR SIGNATURE CONTRA TOR SIGNAT ST A OF FL)7/Gr/)FA COUNTY OF The foregoing m,,sment ackn wled ed before me th g lLL day of J 20 , who 's personally known to me or who has produced as identification. STATE OF FLN&I COUNTY OF The foregoing ins ment��acknowl� d before me this day o,, 20 by who s personally known to me or who has produced as identification. cr - w wry- • 7 .�,�,y ruonc`State of Florida Type or Print Name of t as RDES ALVAREZ VEGA T e or Pri YP oyb�imission Expires Jun 12, 2010 Notary Public -State of Florida%` a isCsi�4n 1DD 528363 My Commission Expires Jun 12, 2010 Commissio �te�f91 Notary Assn. Commission N ) Commission # DD 528363 Bonded By National Notary Assn. NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION. For specific instructions see appropriate permit checklist.