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Home My WebLink AboutBUILDING PERMIT - CERT OF CAPACITY - ZONING COMPLIANCEBP #: 015 flyl TOWNSHIP: RANGE: MAP NO.: f SECTION: ZONING: LAND USE: LOT CVG %: /� i fjTAZ NO.: 1 � FLOOD ZONE: FIRM MAP #: /. Lj 1ST FLR ELV: MAX HGT: CST TYPE: OCCP TYPE: //�l� ///�//// MAX. OCCP: - # OF FLRS: �3 WATER: n I ` SEWER: SPRINKLERS STORMWATE fAl l, R LOT OF REC (b( fr 1/90) LOT OF REC (aftr 1/90) LOT SPLIT LOT SPLIT 1 REQ'D APPRV'D - I .D �-- "DECAL LIBRARY p00 PARKSPk 00 NUMBER IMPACT FEE D FEE FEE j REPORT ! CODE 1 PUBLIC BLDG''(( =IMPACT FEE/ ^ 45 HABITABALE AREA RADON FEE �d 7 I! j 1 t�7 SS i l V lib . (RADON +� �^ " Y N ROAD IMPACT ZONE GROSS ROAD ; IMPACT FEE CREDIT TOTAL ROAD FEE j ' r LI`, DUE /') 11 ` 'V/h• `I'/1 IMPACT SCHOOL- - CREDIT TOTAL IMPACT FEE G 0 - - - .:;=..gam ��r:„�_�` �. SCHOOLIMPACT FEE P9E16EFEE FIRE FEE - MISC FEES: TOTPOLAL P• } �� - '! MISC. FEES ADDITIONAL SPECIFY: r%/'I/j %31YtIC TOTAL ALL PERMITS v� G JJ FEES I REQD IV REVIEWS ZONING ZONING PLANS -VEGETATION SEA MANGROVE .REVIEWED BY EXAMINI G 9, TURTLE DATE COMPLETE INITIALS QF�S_ i IT:. PLAN REVIEW FEE: 1 rJ O RECEIPT NO.: EEDLq PERMIT NUMBER: CONCURRENCY FEE: c-� 5 RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE a FILLED IN TO BE ��e caGy, ST. LUCIE COUNTY PUBLIC WORKS— ~_ BUILDING &ZONING DEPARTMENT StC`�P )c-t rC� 2300 VIRGINIA AVENUE P 1 Ci S l s 20R10Q o FORT PIERCE, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT &ems CERTIFICATE of CAPACITYIZONING COMPLIANCE q PROJECT INFFOOR�MATION(- pW1_kc4li9s 1. LOCATION/SITE ADDRESS: I E cf 1I rp� 2. S/D NAME: ✓� U1?� Pc5 SLAN NAME: a CANNED 3. PROPERTY TAX ID #: �� - (mod I O `ib 1 -I/�I St. Luce County 4. LEGAL DE IPTION (attach extra sheets if necessary): ( W� �\ rUl aL�� "1 2�'v-OL1QX1 � 5. PLAT" 6. PAGE 7. BLOCK 8. LOT BOOK a2$O NO. do NO.. / �6 `' _ NO. Q4 9. PARCEL SIZE: ACRES/SQ FT. LOT DIMEN IONS to� � IOS '4 1 60 X O O 10. DESCRIPTION OF CONSTR CT10kN WO EC1 p� � N TOR WORK ACTIVITY: 11. SETBACKS (ACTU ) FRONT: BACK: RIGHT LEFT SIDE SIDE: . 54-r 3-7.S0 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) 50_ 0 O Nj EW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL OTHER (SPECIE u� S� eu st 3I`� 13. DESCRIPTION OF PROPOSED USE: 14. Sq. FUCONSTRUCTION: n-jj O 15.. S t. 1st 9:1"r. 1`1-7 16. VALUE OF CONSTRUCTION: $ t The value of construction is used to determine the amount of permit fees to be assessed. St Lude County reserves the right to question andfor 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 $25W or more, a RECORDED Notice of Commencement must be sutxniited with this apploa5on. , SLCCDV Form No.: 001-02 - CERTIFICATION: OWNER INFORMAL NAME: ®,� p /� ADDRESS:— e-,r , i"`�J - (i' CITY: - STATE: ZIP PHONE (DAYTIME)-- f 1 IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE TMPLE TITLEHOLDER: ADDRESS CITY: \� - STATE: ZIP PHONE (DAYTIME): f ) CONTRACTOR INFORMATION ST. of FL REGJCER'h#: 1-. BUSINESS NAME: _ QUALIFIERS NAME-. ADDRESS: CITY: PHONE (DAYTIME): ARCHIjMUa1NEER- ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY. ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CRY: 7f1�-- s�f'stc z- COUNTY CERT #: STATE ZIP FAX NO. STATE: _ _ ZIP f • ,�_ 1 �._�0 1 LN�w I 6, Mm.a �,� i i • 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. 1 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. 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. I understand that separate permits may 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 AFFIDAVIT: I certify that all the foregoing information is accurate and that all work 'II be done in compliance wi all applicable laws regulating construcV*QQ and zoning. I f.OWN I NT CTO SI NATURE CONTRACTOR SIGNATURE ' STATE OF FLO ID STATE OF FI� COUNTY OF COUNTY OF � The foregoing i strument as ackngwled$� The foregoing trumen as acknowledged ` �ef e e thi day o}V 2 , by+� be Te thiJP? day of 20�( , by tVtr oI� who' ersonall _ own to me or who who is onall known t e ' h prod ced s identification. or ho ha r d ced = as identification. rstr Signatur of Not ry ignaturfNot �_ _ VN IO� o� ada Type or Print Name of Notary Type of Print Name of Notary o z dwed 9 wz Notary Public Title _ ; MY COMMLORI ISSION q Dp 2H77gy Notary Publliic Title s g w ` EXPIRES: JUne 1, 2007 0?,177 (O / } _ b2L7 ' r,'m °P`eondw Thm Nou Pob5c Undlw r. Commission Number minission Numbe,,,¢ A. (seal) (seal) as NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEWBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.