HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - CERT OF CAPACITYDATE FILED:
PLAN RVVIEW FEE: RECEIPT NO.: �a7g PERNHT NUMBER:(N46CTgL
CONCURRENCY FEE: - RECEIPT NO.: YD-) 97 CERT. CAP. NO.: I
ALLeINFO MUST BE COMPLETE U FILLED 1N.TO BE ACCEPTED
ST. LUCIE'COUNTY BUBLIC WORKS.,
BUILDING & ZONING DEPARTMENT SCANNED
2300 VIRGINIA AVENUE- - '
ORI�Q- FORT PIERCE, FL 34982-6652, BY
772462-155s St Lucie County
APPLICATION for BUILDING PERIVIIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 3017 W - D711t7rE li LVD-
2. SID NAME: SAtL "C-71E P I_kZ_N 1/ SITE PLAN NAME:
3- PROPERTY TAX ID #: 42% -1 Q-L- 01-15- OOp - S
4. LEGAL DESCRIPTION (attachextra sheets itnecessary): eL+z_A tiNTt l t
t
5. PLAT. /6. PAGE-. 7. BLOCK _. 6. LOT
BiOK 5 !/ NO. S1 ✓ NO. 4 I V NO. . Ilp r l"l I l% V
9. PARCEL SIZE: ACRES/SO FTalS Ikc?& LOT DIMENSIONS (� x 13�
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: tPm5rTeA C.TZON Of A
11. SETBACKS (ACTUAL) FRONT: 3`631 BACK: Lit I RIGHT t LEFT
�r SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[>9 RESIDENTIAL [) COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) _-nn
13. DESCRIPTION OF PROPOSED USE: D W 6l. t_1 trC0 ., .y rt( ,
14. I q FtJCONSTRUCTION .15:_ Sq.-Ft. 1sf Floor. Z-O 5ck"
1B. VALUE OF CONSTRUCTION•' $ ] 1 S,0t,0 3y/
The talus of ctinslmclion is used to determine the amount of permit fees to be assessed. SL Lode County reserves the right to question and/or modify the
indicated value 0f mrstructionddis dmn mbated tttatthe subMitled figures am not coilsistentwith Sbra'lar 47M Of oorsUaetion activities..11 the vahie i5L52500
ormae, a RECORDED Notice of Commencement must be submitted v jh Ws appvcz Bum
OWNER INFORMRTION,
NAME:
�'
Moor 4 AV IENOA Av ENuk� � J I
ADDRESS'_
cL
TT. PIEticE- ... - STATE: T\••
- ZIP.
3R��So .
CITY:
PHONE {DAYTIME):
�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: STATE:
ZIP
PHONE(DAYTIME):
V/
CONTRACTOR INFORMATION -'
•Q'
ST. of FL REGJCERT 37- C-16LO 50b44 ST. LUCIE COUNTY CENT N.
^
BUSINESS NAME: SHE�.I_ RAZOR',S 173t4L
QUALIFIERS NAME- C-%K?TC eb U RNS LI TTO14 lZ
ADDRESS: 4\ N• c-mm sus Wrowrc ISV=TE 4g
CITY- DEI-R*N: STATE.
- 7jPi4-5
,
PHONE (DAYTIME): Ibt.\ I �� Z: ZOO I FAX NO. 5inh
Z1Z ZQDZ
ARCHITIENGINEER: Sr -am o a%( E&
ADDRESS:
Z-Ak1 Qu'tiNiuM BLVO
CITY, SO%tt.Imtr..6Excha s-LATE: N L ilr' 3'34Z-(m
PHONE(DAYnmq- ' �&ol1 (.p$\-'16-is
BONDING COMPANY:
ADDRESS:.
CITY:
VA a
STATE
MORTGAGE LENDER: 'Pi OELZZY �rEObR1�L'$AN "`''i:TtW`sj
ADDRESS- `Z--: SW PRIMA V's5m SI )
CM: PORT ST. L-V C.=F. ;STATE: .V'L- ZIP S_
�lmp*o T. ANT. No-nC1E-z When,a permit •is issued and it is: not °picked up Within 60 dates_
after notification it will be voided and returned to you by mail.
CERTIFICATION:
This applfeatil n is hereby made to obtain a permit to do the work and. installations as indicated, and to. obtain a certificate of
capacity, if appl-icabl% fort e.permiltedwork- .1 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. t 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
j YOUR NOTICE OF COMMENCEMENT -
NOTICE TOJAPPLICANTc AS THE APPLICANT FORTHIS 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.
i --
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-
OWNERIPONTPXCTOR SIGNATURE
-
STATE OF FL 1 A�
COUNTY C • V L( (iL!
CONTRACTOR SIGNATURE
STATE OF FLO A
COUNTY OF ' L 2t u P
The foregoing` trument was acknowledged The The. foregoing ,i(�s'trument
before me this T day of jW112O_t� D -i e before me this v ay of -
�1 M 1010•is,����e__rsonallykno to ??��orwho' CV4lyle 11 �oispE
has nrQ&cEd tom' 01. �= ion" or who has oroduced7Jb5D
tignalure of Notary
�e +vl`?' GDZACOCU,&'
Type od Print Name of Motary
Notary Public Title
Signature of Notary
Gvy ce)CUa) ,
Type of Print Name of Notary
Notary Public Title
t�
by
pp Number Commission Number
l LgC-STATE OF FLOPJDA N TARY PUBLIC -STATE OF FLORIDA
(seat) =,Beatriz Goycochea (sea�,,•,.,,,Beatliz Goycochea
S ,Commission.#DD589694 :Commission#DD589694'
BONn �ires: JULY 01, 2007 ' uEs: JULY Ol, 2007
NOTE: TWO (2) SIGN � �N/ QUIRED. EACH SIGNATUR�"10 0M@Rl E0, INC.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERlBUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION,
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ZONING:
LAND USE:
LOT CVG %:.
TAZ NO.:
FLOOD ZONE:
, X
v \
FIRM MAP #:.
`�
1ST FUR ELV:_ ,
MAX HGT:
CST TYPE-
OCCPTYPE
MAX. OCCP:
# OF FLRS: -
'
WATER:
rQ,/l
SEWER
SPRINKLERS
STORMWATE
R
LOT OF REC (Delr 1/90)
LOT OF REC (aftr IM)
LOT SPLIT
LOT SPLIT
RECI'D
APPRV'D
I
NUMBER
IMPACTFEE
IMPACTFEE
�jl�`'�
FEEMR
FEE
j REPORT
PUBLIC BLDG '
� �5,
HABITABALE
RADON FEE
S 0
1 CODE
`O `
-IMPACT FEE
n^
RADON
,iy0• l(�
G4
G
Y
N
ROAD
Ih`•
GROSS ROAD
�j L
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACTFEE
/�IvV
IMPACTFEE
1
DUE
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I
SCHOOL-
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CREDIT
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IMPACTFEE
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IMPACT FEE
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FEE
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FIRE FEE
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MISC FEES:
(�
pO�LICEIFlRE/
E►�c�s
-
MISC. FEES
ADDITIONAL
SPECIFY:
�LrC,�fgAl/CCiG
TOTAL ALL
PERMITS
READ.lar.
,gyp
FEES
P/N
A/IN
REVIEWS
ZONING
ZONING
PLANS.,
'VEGETATION
SEA
MANGROVE
.REVIEWEDBY
EXAMINING
TURTLE
DATE ..
L /
Lit I
COMPLETE
�/
.O.T%
INITIALS
DATE
PLAN
(i -kb
-u1-
EW FEE: — � ' RECEIPT NO.: Sa7�� PERW IRT NUMBER:
ENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
INFO MUST BE COMPLETE u FILLED INTO BE ACCEPTED
ale cow D;tiV�y4ky PEFIM'
y EQUVRED. ST. LUCIE COUNTY PUBLIC WORKS
D BUILDING & ZONING DEPARTMENT
�0 ® 2300 VIRGINIA AVENUE
ORIOQ' Yes FORT PIERCE, FL 34982-5652
`1 (D �1lltty"�•u 772462-1553
)ate
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE -
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: ('' D z XT:E gLV D -
2. S/ NAME: 5N% L.j E- PI-rc&N SITE PLAN NAME:
3. PROPERTY TAX ID #: [ 420 --1 O-L-o1Y15- Ooo - 5
4. LIGAL DESCRIPTION (attach extra sheets if necessary): LOT VD, %I, [% , gWUC A-1 . S kN LuLI6 PL#ZA UNIT l t
I
5. PLAT. /6. PAGE - 7. BLOCK B. LOT
BOOK rj !/ NO. S1 ✓ NO. At ( [% NO. . I(o r V1
s�Ql100 t t
U. PARCEL SIZE.- ACRES/SQ FT. AVIS ACO& LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: CotaSZRucS1oW of ♦s
NEw bzNroLE PMZ�y klo (
11. SETBACKS (ACTUAL) FRONT: BACK: Lq I RIGHT t LEFT
- SIDE �i SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes) —
DQ- NEW CONSTRUCTION [I EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[)9 RESIDENTIAL [ ] COMMERCIAL [) INDUSTRIAL
[ J OTHER (SPECIFY)
13. D SCRIPTION OF PROPOSED USE: DW6t-7X NCoy r�
14. Sq. FtJCONSTRUCTION: 2.C) S`I V. .15._ Sq. Ft. 1st Floor
16. V LUE OF CONSTRUCTION: $ t) S I Oco
The va1Je of canshuction is used to determine the amount of permit fees to be assessed. St Lucie County reserves the right to question and/or modify the
meted value Of constmcton4f it Is demonstrated that the =*brined figures are not caitr lsistenty similar hTes,of constructon activities. t the vahie is $2500
Or more, a RECORDED Notice of Commencement must be submitted vat1 this apptcatom