HomeMy WebLinkAboutBUILDING PERMIT APP - CERT OF CAP - ZONING COMPOFFICE t6E ONLY:
DATE FILED: _
PLAN REVIEW FEE
CONCURRENCY FE
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RECEIPT NO::
RECEIPT NO..: _
PERMIT NUMBER: _
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLEll I.N 'I U I:5r Al,l,ar
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772.462-1553
`'- ti 3
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
INFORMA
LOCATIONfSITE ADDEhbN:,
PROJECT NAME: SITE PLAN NAME:
PROPERTY TAX ID ��
LEGAL DESCRIPTION (attach extra sheets if necossary):
N � 'l MPcPaf �,r. 1�+ ►til
PLAT BOOK 6. PAGE NO. 7. BLOCK NO.
PARCEL SIZE (ACRESISQ FT.): LOT DIMENSIONS:
tJLI D QT
8. LOT NO.
CONSTRUCTION PROJECIT OR WORK ACTIVITY:
SETBACKS (ACTUAL) FRONT: 10 BACK: 1 S RIGHT SIDE: LEFT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [.]USTRI
RIORIND�
OTHER SPECIFY)NOVATION
[xj RESIDENTIAL I ] C°ivnvffiRCIAL L ]
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: 15. $F. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $c�
he
The value of construction is used to determine the amount of permit feo not consto be istent with ssse(L St imilar types of conucie County struction eS the right
to question
the value is SZ50odifY t m indicated
value of construction if it is demonstrated that the submitted figures and not coon
RECORDED Notice of Commencement must be submitted with this aff
SLCCDV Form No.: 001-02
UPDATED 6125/09
FORMATION
1 k -
NAME: u, )QATM ISOIe. F •y,IN' -� e
ADDRE//SS�S:->-lo -nc �aDA�'
CITY: pi C Min �0./`r` STATE: — ZIP: `I '
PHONE (DAYTIME): (_� Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESSBE W.
FEE SIMPLE TITLEHOLDER: I A
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): C__
CONTRACTOR INFORMATION
ST. of FL REG.CERT # I al- I Oa' S`
BUSINESS NAME: L;eA's 1`i01�
QUALIFIERS NAME: a,
ADDRESSS: �_riOO ��TX i r
CITY: `l "+
PHONE (DAYTIME): M03 S�-e
ARCHIT/ENGDUMR: N
ADDRESS:
CITY:
PHONE (DAYTIME): (___)
STATE
ST. LUCIE COUNTY CERT
'w
BONDING COMPANY: N �P
ADDRESS:
CITY: STATE
MORTGAGE LENDER n) A a
ADDRESS:
CITY: STATE
IMPORTANT NOTICE: When a permit is issuei 't hQ.t
it will be voided and returned to you by mail j
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 thatail
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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the 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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FI�YE]Dy1
COUNTY OF A R�
The foregoing instrument was acknowledged before
me this (S�L( dday o 20 17' .
by Li A fOSna.c(^`
who is personally known I/ or has produced
as identification.
Pigna re of N t y
CONTRACTOR SIGNATURE
STATE OF FL
COUNTY OF
The foregoing rostrum was acknowledged before
me this 0 gday o 20 j
by L Si- 1-RSr icy c
who is personally known _V or has produced
•���n,,.,� as identification.
SG r
Signature of
Commission No. �- -7�e CommissI
unnry nnln` ARt(I)NG
,ygNCyy�i \t<�. STRONG
- MY C.OIN'-nISSI0N It EE059652
My COMMIS # EE059652
E:XPIkESJanuary30,2015
EXPIkES day :0, 2016 tN „a „wocom NoksNoW Sorvlca.com
NOTE: TWO (2) S SIGNATURE 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.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #: i�
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
)
f VVV
1sr FI R ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FIRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 111990
LOT OF REC
A&er 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BID
IMPACT
FEE
GENERAL,
PARKS
IMPACT —
FEE
SCHOOL
IMPACT
FEE
ROAD CREDIT
IMPACT
FEE
Y N
LAW ENF
IMPACT
FEE
FIREXMS
IMPACT
DRIVEWAY Y N DRIVEWAY
REQUIRED FEE
—
ADMINISTRATIVE
VARIANCE FEE
FEE
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF _ NON -CONFORMING
ELECTRIC --L7�GAS LOT OF RECORD
PLUMBING ✓ FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING. _!
REVIEWS
FRONT
COUNTS
ZONING
REVIEW
SUPER OR
RE W
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE6/7
RECEIVED
DATE
COMPLETED
O
INITIALS
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