HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - CERT OF CAP - ZONING COMPOFFICE USE ONLY:
DATE FILED: >j>eeg�QQ'� (vv(��1��,��1lJJ / �)
PLAN REVIEW FEE: RECEIPT NO.: rt$1 PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
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ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
� BUILDING &CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652 '�j O /t `
772-462-1553 SCANNE't�
BY
APPLICATION for BUILDING PERMIT St Lucie Cow
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:.1.9 1.5� W . K A.-N" (Z
2. PROJECT NAME: Q kAw0,4 PRo NS SITE PLAN NAME:
3. PROPERTY TAX ID #: Z Li 0 — a I — 0 O O ) — (9
4. LEGAL DESCRIPTION (attach extra sheets if necessary): e (I2 O N E X4 a R rW 0 Sr �i
1-ts.s M;&t,," RX, as 'rr _0 (t ").1'0-[A47 wed 3369-7a3- K•aa7 kC.
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
t I _
9. PARCEL SIZE (ACRES/SQ FT.): LI r LOT DIMENSIONS: 330 X G 19 t
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: R L S % 2 _C_
SETBACKS (ACTUAL) FRONT
S� BACK: 3Y'— R
Nin
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [vrCOMMERCIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: 13 0 O
VALUE OF CONSTRUCTION: $
06000,00
LEFT SIDE: !\J tj
Ni
[✓rINTERIOR RENOVATION
[ ] INDUSTRIAL
15. SF. FT 1st FLOOR:
The value of oonstmction 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 ofconstruction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. Ifthe value is $2500 or more, a
RECORDED Notice ofCommencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION
NAME: OaprubXV QtLe'riNe" Qus14,C-SS PRop,
ADDRESS: 106901 LJ . 9,, _
CITY: V-4 . N e M c t STATE: F I- ZIP: 3 A/ 9 +/ S-
PHONE(DAYTIME): (1723 W4 - g/6O Email: --rcyO APo.o:4�bRg-Kcrs,C0ek
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): i_-)
CONTRACTOR INFORMATION
STATE:
ZIP:
qy3� 'PloP91
ST. of FL REG.CERT #: G Ce r. 150 40 4 O ST. LUCIE COUNTY CERT #: I Si O - 2" pO l 00 Zs -
BUSINESS NAME: -
QUALIFIERS NAME:
LL C-
ADDRESS: Z g S I W. M A W A%f k O
CITY: f -J. f I" C-C_ STATE: FL- ZIP: 31 q �
PHONE (DAYTIME): Cll2) gbl,e)(e0 FAXNO.7724(.4-631.o Email:
ADDRESS: .11) 1 1" JLJ W LSTI
CITY: STATE:
PHONE (DAYTIME): 1-7
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
ZIP:
ZIP:
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, 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.
nttk 1�
OWNER QR CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF ST • LAxc I t
The foregoing instrument was acknowledged before
me this —25o day of Di -r 20 12
by Nr P¢t Pa
or has produced
si "' "1o• JENNIFER A(FMkE
Notary Public - State of Florida
My Comm. Expires Oct 4, 2015
Commission M EE 135843
i
e�i'•CTIOR
STATE OF e r
e
The foregoing instrument was acknowledged before
me this 3 O day of /� c T- , 20�
bye Ea.t r c�c who is is personally known or has produced
�uuiFER MEDKWI)
Notary Public - State o1 Florida
My Comm. Expires Oct 4.2015
Commission 4r EE 135843
NOTE: EACH SIGNATU NG FOR
THIS BUILDING PERMIT AS AN OWNERBUILDER, THE O R 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 OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP
SECTION
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TOWNSHIP
RANGE
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MAP NO.
ZONING
LAND USE
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N
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
IsT FLR ELV
GT
CONST TYPE
OCCUP TYPE
MAX OC
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before I/1890
T OF REC
After 1/1990
LOT SPLIT
REQUIltED
LOT SPLIT
APPROVED
REPORT
CODE
O
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
(RADON)
LIBRARY
IMPACT
FEE
PUBLIC BID
UAPACT FEE
CORRECTION
PUBIC BID
IIdPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
FACT
FEE
FIRE/EMS
IMPACT
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
_
FEE
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF _
ELECTRIC GAS _
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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