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HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT CERTIFICATE OF CAPACITY' r , BP CTION:� TOWNSHIP: RANGE: MAP NO.: NING: �UD LAND USE:.. _ . ., LOT CVG %:. TAZ NO.: DOD ZONE: FIRM MAP #: C5 1 ST FLR ELV: MAX HGT: T TYPE: OCCP TYPE: , _... MAX. OCCP: # OF FLRS: ffER: � r, 1 C SEWER: wvsc��fN SPRINKLERS STORMWATE (/� R T OF REC (befr 1/90) LOT OF:REC (aIV 1/90) LOT SPLIT LOT SPLIT 4 REQ'D APPRV'D CAL MBER LIBRARY IMPACT FEE PARKS IMPACT FEE "�� PERMIT FEE I PORT DE fo PUBLIC BLDG IMPACT FEE ++/ HABITABALE AREA RADON FEE $ �. / (RADON) ..' j�GL I ' l N AD ZONE GROSS ROAD CREDIT TOTAL ROAD_._ -ACT 3 IMRACT FEE: _. DUE• :: • _ ,. .: :IMPACT. FEE .. -.. • - I i HOOL • 1 EREDIT Y iX T.OTAL i I ACT FEE .., t f SCHOOL ,...,_,. ' •IMPACT FEE i' LI E FEE i FIRE FEE �( MISC FEES: TOTAL M POLICE/FIFtEJ MISC. FEES , Y N )ITIONAL. SPECIFY: Q� TOTAL ALL WITS :.FEES YD .EVIEWS ZONING = 'ZONING" PLANS VEGETATION" SEA .; MANGROVE `'REVIEWED -BY EXAMINING,.:-! .,, , ,. E NPLETE UF.E�O,�.ILY --C►A-T-E-FILED:-- PLAN REVIEW FEE: CONCURRENCY FE ALL 11 RECEIPT NO.: / _ PERMIT NUMBER: O'S-lJ,;) /©� l :U_-0V RECEIPT NO.: CERT. CAP. NO.: Jl iC'r tDt fqA1/Di L"TZ imp i'ii i rw% i1i TA DL' A''^ncTtfTC➢1 coGy;. - b`T:rLUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE, L '2ORIOQ FORT.PIERCE; FL'34982-5652 561-462-1553 APPLICATION for BUILDING PEWY11T CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADQ3ESS: LJ P� 3 t4 9 9 X!5 2. S/D NAME: VJ Ll-&C—E SITE PLAN* NAME: 3. PROPERTY TAX ID 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. ;PLAT': q2) 6. PAGE a :-8i-:LOT BOOK_ 'NO.1. a C No . NO. 9. -PARCEL-SIZE: T. 164 �S- / � a` LOT.DIMENSIONS L 10. DES CRIPTION CRIPTION OF CONS .,,.,... CO _ •.- .� S• �1�1 N � • D . V 11. SETBACKS (ACTUAL) FRONT: BACK: RIGMT�_ � ^ LEFT SIDE T� SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) M NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION DCJ RESIDENTIAL. [ ] MMERCIAL. IN [I OTHEI�`($PECIFY) .CO : I �...._ _ 13. DESCRIPTION OF PROPOSED USE: t�Tt� S t�� 11-Tl 1k L 14. S Ft./CONSTRUCTION: C>�� q• 15.• S,g. Ft. 1 st Floor:... ... . 13. VALUE OF CONSTRUCTION:.$125-� The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the.oght.to 4uestlon,and/or modify the.; Indicated value. of constsucilon•iF iLis.demonstrated-that•the submitted'=figures bremot coAsistent uvith':similar t}ipes of cionstrut:Uon -acttvities. If ifie valde°1§.$2500 or more,'a RECORDED Notice of'Commencement must be submitted with this application. it 1 XDV Form No.: 001-02 r ERTIFICATIOW 'NER.INFORMATION: IE: LTA L - This application is hereby made to obtain a permit to.do the work and installations as indicated, -and -to obtain a certificate .of opacity, If apPlicable, for the..permitted-work.. I -certify .that no work or installation has commenced prior to the issuance of a-pemlit RESS: R-AC-F— U k -,n3c aid that all work will be performed to meet the. standards of all laws regulating construction in this jurisdiction. I understand,that Et_(yl siparate permits may be required for ELECTRICAL, PLUMBING,`SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, 33 .o STATE:. �' �- ZIP l TANKS, AND AIR,CONDITION.ERS, ETC., not otherwise included with this -building permit application. NE (DAYTIME): 1� j 3� y Slo�O The following building permit -applications are exempt from undergoing a full concurrency review:;room additions, accessory IE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS s"ructures_(all types), swimming •pools, fences, walls, signs, screen rooms; utility -substations & .accessory uses to another non- :)W.residential use. SIMPLE TITLEHOLDER: NOTICE TO OWNER: -FAILURE TO .RECORD.A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING REss: TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING STATE: ZIP j YOUR NOTICE OF COMMENCEMENT. HE (DAYTIME): ( ) 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 (TRACTOR INFORMATION V PROMISE IN GOOD FAITH TO DELIVER:A COPY OF THE ATTACHED CONSTRUCTION LIEN #: LAW NOTICE TO THE-PERSQN WHOSE P.ROPERTY:IS SUBJECT TO ATTACHMENT.,, 7f FL REGJCERT G� �� b � l D ST. LUCIE COUNTY CERT #: NESSNAME: Kn,L.TER 51�N�-r�tR� i�oMES lzsc. 7 + OWNER'S. -AFFIDAVIT: . I certify -that all the foregoing information is accurate and that all work will be done in compliance -IFIERS NAME: ?og�iT J V�4tL i_ with all applicable laws regulating, constru nd zoning. RT 5Tcl. STATE: FL ZIP 9 $ OWNER/C RACT R SIGNATURE CONTRACT - ATUR IE (DAYTIME): (�L) 1j(a �}iD 3 4 , FAX NO. STATE OF FLORIDA STATE OF FLORIDA COUN_ .TK-OF . 5T__�t-ac t G __.:._.:.. - - - 000NT-Y OF IITIENGINEER: i[- B i5 H ER The foregoing iris ment w9s acknowledgeedd � The foregoing instrument w s acknowledged :Ess: Z -�1.00 i-) lG!-1 {� i�� �d�� ... S (> LT� I cb -1-L a� _ is aY ? , by before me thjp. da of...20d , by befor In th of wx--,6t-4 1 � " , o Is erson;N . n o me Who who is ersona known to me B `4G!-�t STATE •L, "SIP 3 �(2lp JL personally ? h s prod ed •as identification. Cor who s produced as I enti Ica „ion. ' E (DAYTIME): (mil 1 �33 8 Jf Si ture of Notary. S' ature of Notary ING COMPANY: l�I /i� ESS: Yn1,n,1�. M o�µf Y'd n/I; rw a+4r Type or Print Name of,Notary Type of Print Name of Notary STATE: ZIP Nota Public Title rY_P I' = Notary Public Title GAGE LENDER: ,g/A _ . r : , r: ! Commissi a NNE tN00RE 2e'; _ . CY pp023p07 Commis Nu )res 91232I? NNE MOORE .SS: (seal) thru t�)`�2 :Comm# DD0232 M Bonded Assn•. Inc- (seal)...::= ExpWos 9/23JP007•, : : STATE: _ Bonded thru 800 432-4254 _._...... ........ _.... ZIP :.. t Florida Notary Assn.. Inc. NOTE: -TWO (2) SIGNATURES ARE REQUIRED. -EACH SIGNATURE MUST BE' -NOTARIZED.' ORTANT NOTICE: IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEF#/BUILDER, THE OWNER MUST PERSONALLY APPEAR When a permit is °issued :and not picked up within 6 da s TO SIGN THIS APPLICATION IN ;THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. r notification it will be voidedand returned to you by 'mail.