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HomeMy WebLinkAboutBUILDING PERMIT - CERT OF CAPACITY - ZONE AND COMPLIANCEJ OBE' CE USE ONLY BP #: - -- — i SEGT1�N TOWNSHIP RANGE I MAP NO. LM � J ZONING V LAND USE W LOT CVG % TAZ NO. Fz 00D ZONE FIRM MAP # 1ST FLR ELV - MAX HGT -- CONST TYPE OCCUP TYPE / J MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 111990 After 111990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE AREA FEE FEE - (RADON) LIBRARY PUBLIC BLD PUBIC BLD PARKS. IMPACT IMPACT FEE HVIP IMPACT . FEE CORRECTION E FEE GENERAL SCHOOL ROAD CREDIT Y N LAW ENF IMPACT CT IMPACT FEE FEE FEE FIRE/Ems DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE IMPACT REQUIRED - FEE VARIANCE FEE SPECIFY MECHANIC ROOF NON -CONFORMING SUBS ELE GAS LOT OF RECORD REQUIRED PL ING FEES . II DATE SENT TO ADDRESSING. - REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION COUNTER REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE MISCELLANEOUS FEES S //w SEA TURTLE I MANGROVE REVIEW REVIEW - - DA-T-E-FIL-ED:— PLAN REVIEW FEE: D RECEIPT NO.: _1 L� NII PERT NUMBER. �� 6Vq CONCURRENCY FEE: RECEIPT NO.. CERT. CAP. NO.: ' ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED ry 1E:GGG. Gl/000 St. Lucie County Building and Zoning No01 2300 VirginiaAvenue_(��� -'`rORt4p Ft_ Pierce, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT ti PPI-i6,g. Yi ®"v CERTIFICATE of CAPACITY/ZONING COMPLIANCE �ve PROJECT INFORMATION d 1. LOCATION/SITE ADDRESS: Q S ©® 5 o CC—►Jtv 2. PROJECT NAME: SITE PLAN NAME: 3. PROPERTY TAX ID #: y 102— � 5-0 Li — 69069 0 -- (50 /C) 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 7S00�/ 5. PLAT BOOK 6. P GE NO. 7. BLOCK NO. 8. LOT NO. .61 10. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR e 1. - -A - �) _ n n — 11. SETBACKS (ACTUAL) FRONT: N1W BACK:- RIGHT SIDE: W kjAr- LEFT SIDE. 12. TYPE OF CONSTRUCTION (Check all appropriate boxes [ .], NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION ]' RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [x OTHER (SPECIFY) j IN S 'S >A_ ri E) d'"e sI4 13. DESCRIPTION OF PROPOSED USE: 14. SQ. FT OF CONSTRUCTION: D �15. SF. FT 1st FLOOR: 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 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 n NAME: 14" L'a lM a � �" �; tv\ C ADDRESS: 3.8 6 O S C.l&C--n(y CITY: G-p /1 S QM � zJi.� ,� STATE: L__ 2 P: p3 \� 5 5-% PHONE (DAYTIME): �( Z-Z-a ' Z� Email: ARC JP -`�S L4'�'L�•i f� trl� IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: w i ��-✓Q �u�`- �n "'�i" I��a C- C" f v1e ADDRESS: Q O 6-A-O IDVI\ ) CITY: _P��..�.pM �.¢r� STATE: � � ZIP: �Q PHONE (DAYTIME): CONTRACTOR INFORMATION ST. of FL REG.CERT #: CGC 1,32,1(0 7 q ST. LUCIE COUNTY CERT #: BUSINESS NAME: Iv •� Cc `r' - b� QUALIFIERS NAME: 11t • 4, ADDRESS: /" © 13 O g p� CITY:17 a STATE: / ZIP: PHONE (DAYTIME): " o[ Cd " L� 2 A FAX NO. 7 2,2 . 'It 3 _ J -0 Email: /p. � 2 ��y�•C� ARCHIT/ENGINEER: iJ' ADDRESS: `(CLv CITY: NP- a l STATE: �.(, zip: d MPHONE (DAYTIE):%%, L/% BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: 0?&o®l IWORTANT 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, PLUM MING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application. St. Lucie County makes no representation that its granting of a permit will authorize,.eth.permit holder to build the subject structure which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. 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. 1 TRACT IGNAT / CONTRACTOR SIGNATURE Oti R STATE O FL STATE OF FLORIDA COUNTY OF � , 4- -1 COUNTY OF The foregoing instrument was acknowledged before me this day of 20,1'6), by who is personally known _�orhasroduced identification. Signature of Notary-" gg Commission No. NOTE:. TWO (2) SIGNATURES ' THIS BUILDING PERMI1���y ,og THIS APPLICATION IN T / OWNER BUILDER AFFIDAVIT The foregoing instrument was acknowledged before me this day of by who is personally known 20 or has produced as identification. MULIgp ////� Signature of Notary Commission No. (Seal) #DD78M o= SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR • DER, THE OWNER MUST PERSONALLY APPEAR TO SIGN D ON THE FRONT OF THIS APPLICATION. ,BE REQUIRED FOR ALL OWNERJBUILDER APPLICANTS. For specific instructions see appropriate permit checklist. w