HomeMy WebLinkAboutBUILDING PERMIT - CERT OF CAPACITY - ZONING COMPOFFICE USE ONLY:
DATE FILED: 8(p PERMITNUMBER: rofL'-0I 4-1
PLAN REVIEW FEE: RECEIPT NO.:S
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
-
St. Lucie County Building and Zoning
2300 Virginia Avenue ,'
Ft. Pierce, FL 34982-5652 `SCANNED
772-462-1553 BY
St Lucie Counl
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SSInITE--ADDRESS: q�� \41 / W c& r��N dTC�ZT ri �twCt
2. SID NAME: U L'��:Fil E!iC' �� I.,c tvTE PLAN NAME: �111d1j I11Qkao
3. PROPERTY TAX ID #: S4Q3 - S'0Z - �q_) M /_3
4. LEGAL DESCRIPTION (attach extra sheets if necessary): kM[lt r^JIV 3(0 yQ 0 J-kieFS CIF
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK 91 82 NO. �r NO. NO.
184, 601
9. PARCEL SIZE: ACRES/SQ FT. y. Ill LOT DIMENSIONS
10. DESrION O CONSTRUCTION P OJECT OR WVORK ACTIVITY: /�7UR/Vf /AdrGKOI/ rLru1^
401j le--
11. SETBACKS (ACTUAL) FRONT: ZBACK: RIGHT: LEFT:
—Z SIDE SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes) _
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION INTERIOR RENOVAT
[ ] RESIDENTIAL [♦COMMERCIAL [ ] INDUSTR
[ ] OTHER(SPECIFY) /f
13. DESCRIPTION OFPROPOSED USE: ntut11F�ujaj CJS�t I�
14. Sq. FtJCONSTRUCTION: �L-1 ig 15. Sq. Ft. 1st Floor: V
16. VALUE OF CONSTRUCTION: S _TOLD
The value of construction is used to determine the amount of permit lees to be asst?ssed. 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
Y/
r I,
K n.:
OWNER INFORMATION
NAME: n2nt4I22..'�"b� E %2-a T�
ADDRESS: `4- njo9-44IL ,V—E &VD1�
CITY: '?0. iILI ffiNgAA�e�L? fY r 1S- STATE: r lJ ZIP
PHONE (DAYTIME):�M- - 2n1•IBg-� email:-K0UE1Z&l=i4/.Ul.• i% .C!UAl
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: !&1,AM SSA1\XI1
ADDRESS:
CITY:: thj _ SAC_ &4D1Mft STATE: Fi� ZIP 3341
PHONE (DAYTIME): iM. • on • VR�p.
CONTRACTOR INFORMATION �7
ST. of FL REG./CERT #: nw o�3 11j $ ST. LUCIE COUNTY CERT #:
T • �`
BUSINESS NAME: _,
QUALIFIERS NAME: _
ADDRESS: 1_
CITY:
PHONE (DAYTIME):
ARCHIT/ENGINEER: _
ADDRESS:
.110
CITY:
PHONE (DAYTIME): (�
BONDING COMPANY:
ADDRESS:
CITY:
STATE: �D. ZIP 34 R 57—
STATE:
ZIP
MORTGAGELENDER:
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.
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 AFFI T: I certify that all the foregoing information is accurate and that work ill be done in compliance
with all applicable laws regulating construction and zoning.
77
OWNE O TRACTOR SIGNATURE CONT CTOR SIGNATURE
STATE OF FL A
COUNTY OF ggLIC!�_
The foregoing i rument w aknowledged
before it yf 20a by
oisd d,.& F.44 dkac �ersonally?
known to me or who
Type or Print Name of Notary
Commission No. (Seal)
STATE OF FL IDA
COUNTY OF n�ry� PJLh
The foregoing instrument as acknowledged
before me this o 20Q� by
ho is personally
kn2nM.tjLWe or who has produced'
i as identification.
or
No. (Seal)
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.
This fax was received by GFI FAXmaker fax server. For more information, visit: http:/twww.gfi.com
OFFICE USE ONLY BP #: 0 70°' �` i'4 `✓
SECTION
4
TOWNSHIP
Q/�S
RANGE
MAP NO.
344�(-)IY
r
ZONING
LAND USE
LOT CVG%
TAZ NO.
FLOOD ZONE
FIRM MAP #
aQV F
l sr FLR ELV
MAX HOT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
'
WATER
FALA
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC (after
LOT SPLIT
LOT SPLIT
before I/90)
I/)0)
RE UIRED
APPROVED
ADMINST
LIBRARY
PARKS
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FEE
REPORT
JJ�� ''jj
PUBLIC BLD
HABITABLE
RADON FEE
CODE
VO<
IMPACT FEE
AREA
(RADON)
GROSS ROAD
DIT
Y
N
TOTAL ROAD
IMPACT P&E
IMPACT FEE
IMPACT FEE
�
DUE
SCHOOL
CREDIT
Y
N
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL
Y
N
SPECIFY
TOTAL
PERMITS
11
of ALL
REQUIRED
/�gt '4 1�
FEES
REVIEWS
ZONING
ZONING
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMING
DATE
COMPLETE
NN+4�e7
INITIALS