HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT CERTIFICATE OF CAPACITYSECTION: I C-0 I TOWNSHIP:
ZONING: �,t� LAND USE:
FLOOD ZONE: FIRM MAP #:
CST TYPE: OCCP TYPE:
WATER: I V3& I SEWER:
LOT OF REC (befr 1/90)
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DECAL
NUMBER
j REPORT
CODE 1(O
ROADl�
IMPACT ZONE
SCHOOL -
IMPACT FEE
POLICE FEE
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ADDITIONAL
PERMITS
REQ'D
REVIEWS I ZONING
DATE
COMPLETE
INITIALS
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LOT CVG %:
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i. MAX. OCCP:
LOT OF. REC (aftr 1/90)
LIBRARY
IMPACT FEE
PUBLIC BLDG
IMPACT FEE
GROSS ROAD
IMPACT FEE
DUE
W
CREDIT
FIRE FEE
SPECIFY:
ZONING I PLANS
REVIEWED BY I EXAMINING
SPRINKLERS
LOT SPLIT
REQ'D
PARKS
IMPACT FEE
HABITABALE
AREA
CREDIT
MISC FEES:
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MAP NO.:
X2, I TAZ NO.:
# OF FLRS:
Na
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DATE FILED: /' �' ?-ry to _
- CAN -REVIEW -FEE: /S D. O RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: -:U'-O0 RECEIPT NO.: CERT. CAP. NO.:
ALL -INFO- M-UST-BE-COM-P-L-LT-E-a-FILL-ED -I-N ?O--BE-ACCEPTED---
��G�6 OOGy ST. LUCIE COUNTY PUBLIC WORKS Q
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BUILDING=B�ZONIT�IGEPAR-T_NkEN--__--- --- ---
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2300 VIRGINIA AVENUE
'20R10P FORT PIERCE, FL 3.4982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
i
PROJECT INFORMATION
STORMWATE
1. LOCATION/SITE ADDRESS: le7t Nutien& b?e a bEec
R
-
2. S/D NAME: /eOPICAt Acgcs SITE PLAN NAME: Alene RESIAEAStre
LOT SPLIT
APPRV'D
3. PROPERTY TAX ID #: 4309, (00 O 110 - 600- O
4. LEGAL DESCRIPTION (attach extra sheets if necessary): '4075 SI�Sa * 53 ; lJtOGAC 1. %2pP)EfTL ACQEs
PERMIT
FEE
q p "�" /� p
RCCoedor, '17D � T L4r jtAtrfckC QS ftdjd- ),,y204 T �081� $ �Q�o20 ,O-P-fhe P&6)k kEeoldS of Srl.ucre L' a IkY
RAD EE
F�I-o A
5. PLAT. 6. PAGE 7. BLOCK . -8. LOT
BOOK j NO. ,gyp NO. ,� NO. S ; saw
` 5 j L02 -- � I�OX 3f72 .bs x lso x �-2712
Y
N
TOTAL ROAD
IMPACT FEE
9. PARCEL SIZE: ACRES/SQ FT. /. 0'4 Ac LOT DIMENSIONS /50 'x 304 '
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:—�EAUmA h%MC
- �
TOTAL
SCHOOL
,-
i
Y 5 No cH � D F I�l t � - QoM GlSrf [ct/1 e
A IMP CT FEE
KS BACK: RIGHT. / L
(ACT U AL) FRONT:11. SETBACV LEFT
SIDE .yN `q— SIDE: N<1 ' -q S .
TOTAL
POLICE/FIRE/
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
MISC. FEES.
1
! [ l NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
TOTAL ALL
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
FEES
DQ OTHER (SPECIFY) Reba; ld due -to .)Jaunt&. e
i
13. DESCRIPTION OF PROPOSED USE: !•festden-i is
VEGETATION
-
SEA
TURTLE
MANGROVE
14. Sq. Ft./CONSTRUCTION: 30oi� 15. Sq. Ft. .1stFloor:
dj
16. 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 co0sistent with similar types of construction activities. If the value is $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
ril
so
SLCCDV Form No.: 001-02 , .
OW
NER INFORMATION: (/
NAME: A)A 7YA,0 A�21CM
ADDRESS: 241136 F Aquadwrsr bk_
CITY: - - - - kjyjto -STATE:- -- - -- - ZIP --
PHONE (DAYTIME):
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: CIA
ADDRESS
CITY:
STATE:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG.ICERT #: ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
STATE:
FAX NO.
ZIP
ZIP
ARCHIT/ENGINEER: PQ.0 I Welch ANC
ADDRESS: j98'y S1J ;6l I A,0re ST 4 )14
CITY: Por-r St Lucie STATE: - zip'. 3-q
Uq
PHONE (DAYTIME): (71a 85
BONDING COMPANY:
ADDRESS:
CITY:
STATE:
ZIP
MORTGAGE LENDER: .1✓t' )Y1 "Utuoi
ADDRESS: = 9210 En tannm
CITY: !' CI C '1SDI STATE: G ZIP 9SnI
& C�iCc-� 2 J'
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.
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
with all applicable laws regulating construction and zoning.
�nle�5: __1
WN ONTRACTOR SIGNATURE
STATE OF FL IDA
COUNTY OF _Woe
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing in ment was acknowledged
before me this day of , 20 , by
4duced
ho is personally known to me
or who hasp as identification.
Signat9fe of Notary
pe of Print Name of Notary
Nota�Public Title Notbnj Public Title
�A �3liQ /4 Commission Number Commission Number
(seal) : q 'Py c: Denise Parker (seal)
_.. , MY.COMMISSION# DD130919 EXPIRES
.130
September 7,1006
BONDED THRUTROYFAININSURANCE INC
NOTE: 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.
The foregoing instrument was acknowledged
before me this ZWkday oflft(D4 20Q[Q, by 60_4 l'I
Vnc_I[, , who is personally known to me or who
has produced-ll as identification.
IC)AA'1
Signature of Notary
ban Ise T1$, r'
Type or Print Name of Notary