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Home My WebLink AboutBUILDING PERMIT APPLICATION - CERT OF CAPACITYOFFICE",USE:ONLY: FLOOD ZONE: FIRM MAP #-. 1ST FLR ELV: MAX HGT- CST TYPE: OCCP TYPE: MAX.00CP: # OF FLRS: WATER: PSI)!I (, SEWER: SPRINKLERS S RTORMWATE LOT OF REC (befr 1/90) LOT OF REC (aftr 1190) LOT SPLIT LOT SPLIT kEQ' D APPRV`D DECAL LIBRARY PARKS lof PERMIT NUMBER IMPACT FEE- IMPACT FEE FEE REPORT CODE PUBLIC BLDG IMPACT FEE HABITABALE AREA RADON FEE 9c> (RADON)- ROAD- , PUL GROSS ROAD CREDIT' Y N TOTAL ROAD IMPACT ZONE IMPACT FEE Q)l IMPACT FEE DUE Y N_ .7 ... ....... SCHOOL' CREDIT TOTAL IMPACT FEE .. . .... SCHOOL IMPACT FEE POLICE FEE FIRE FEE MISC FEES: TOTAL POLICE/FIRE/ MISC. FEES ADDITIONAL 'EQT) Y N SPECIFY. TOTAL ALL PERMITS FEES R REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE -REVIEWED 13Y EXAMINING TURTLE DATE J7 /7 COMPLETE D r d 0 L mqzjrrapro=�O- WWW's RECEIPT PLAN REVIEW FEE: I NO.: PERMIT NUMBER: CONCURRENCYFEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO 14FIST BE COMPLETE FILLED IN TO BE ACCEPTED on C L/"/ ST. LUCIE COUNTY PUBLIC WORKS BUILDING -&ZONING DEPARTMENT 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 561-462-1553 B ..,P,.LICATION for. BUILDING PERMIT CER�'YFATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: 2-G145 We--,-T mtowAv ROAD 2. S/D NAME: SITE PLAN NAME: 3. PROPERTY TAX ID 405 - 14 Z I - 0001 - 000 t2- 2.0 -7 z- 4. LEGAL DESCRIPTION (�`�'ch extra sheets if necessary): 5 L4 0 ra 1/2- 0 OF i\) c, I= e--;, S /14 1 o LAj A Y P, 0 A 5 IN(4-1,19 A C7) t. 5. PLAT ",',,6,. PAGE 7. BLOCK 8. LOT BOOK NO. NO. NO. 9. PARCEL SIZE: ACREt3/SQ FT. 14. t, q A c- LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: EX 09 A M.51 n &1 6 F 1-1. SETBACKS(KdTOAL) FRONT: BACK: RIGHT LEFT SIDE SIDE: 12. TYPE -OFCONSTRUCTION (Check all apoeopfiate boxes) I NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION -RESIDENTIAL, COMMERCIAL INDUSTRIAL OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 09c� 14. Sq. Ft./CONSTRUCTION: ? O'_15. Sq. Ft. 1st Floor: #16. VALUE OF CONSTRUCTION: $ _00 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 ty pes of construction activities. If the value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. 7, k SLCCDV Form No.: 001-02 OWNER INFORMATION: NAME: ?k'IILIP4 TlLOY T)eFttJOy ADDRESS: Z°lK5 w. tintnvJlt'i �(�. CITY:--- - - - 'r'r , P ► �X - -- -- - - -3 Ll9-B J - - STATE: - - r V - -- -ZIP PHONE (DAYTIME): (1 12) 4 L H- 8 1 o o 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): L STATE: ZIP CONTRACTOR INFORMATION ST. of FL REGJCERT #: CGC Ai.3 797 ST. LUCIE COUNTY CERT #:dos v BUSINESS NAME: 'D2AW DV ?*0-M E Ls rJ C_ QUALIFIERS NAME:�OY ADDRESS: Za'y 5 W Yul I OW A Y K b. CITY: i%� . P I t r�r E STATE: ZIP 3 19 8 / PHONE (DAYTIME): ('1?Z 1 41, `(' 8 t L v FAX NO. �7; Ll y - 34Q 0 ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: ZIP ( I STATE: ZIP 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 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, T-ANKS-AND-AIR-CONDITIONERS; E-TC.; 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. OWNER/CONfRACT R SIGNATURE CONT TOR SI&TATURE 3 STATE OF FLORIDA STATE OF FLORIDA �-� COUNTY OF 5.1- , L t c ► r COUNTY OF S-t . L_L r t r1 The foregoing instrument was acknowledged The foregoing instrument was acknowledged before me this Z1 day of MA Y , 20 03, by _ before me this 2-7 day of /V , 20L, by -PHILPtAWO( who is personally known to me or who -710� 772AwLJ7 , who is personally known to me has produced as Identification. or who has produced as identification. Sigroure of Notary Sign ure of Notary i P6T,7Zr,2 /=12 /-TTo e— Type or Print Name of Notary Type of Print Name of Notary 1 Notary Public Title COm si O-'JtNNNIFER POTTORFF Y PU•. MY COMMISSION # DD 024437 *: *- (seal) EXPIRES: September 10, 2005 %:F oc iti°e�� Bonded Thru Notary Public Underwriters Notary Public Title Co °. $c IFER POTfORFF MY COMMISSION # DD 024437 (Seal) EXPIRES: September 10, 2005 Bonded Thru Notary Public Underwriters NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEWBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.