HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - CERTIFICATION OF CAPACITY4_
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DATE FILED A-�� ,� 0 /
PLAN REVIEW FEE: •O0 RECEIPT NO.: PERMIT NUMBER: ��U V �S
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL FO 7T BE COMPLETE & FILLED IN TO BE ACCE) LD
St'Lucie County Building and Zonln ?f .ppSwd
•1 2300 Virginia Avenue
<OR10p' Ft. Pierce, FL 34982-5652
772462-1553 t ?Z&414I `V Q
APPLICATION for BUILDING PERMI
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 707 Ki 77F99�, Q%! Pa4i S� -I, a r-le
2. PROJECT NAME: GRRCCF C.snrnuAL CH.l+sA! SITEPLANNAME: GXq"eF E.s?itNwit)e'Z CHu<cN
3. PROPERTYTAXID#:' 3Y/S-SaI'mosr/-eonf0
4. LEGAL DESCRIPTION (attach extra sheets if necessary): r—J AC/fC/1-
5. PLAT BOOK _ 6. PAGE NO. 7. BLOCK NO. 3 S. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): OT DINIENSIONS: 33� • i� X ��� �''
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
23, 5/4rx 76 ".r3ily %D Exrs->• 73w�D!'� T/t� iF/D�r n eN !S /.0 rrhf r n
.. 5/9.aJGIelA� DY l77/+C G%Cr Sj !^K' �ulL/ilw.s` %Y.(Q3'f�2 v ��eS• (L—�
II. SETBACKS (ACTUAL) FRONT: 260 r BACK: 11 RIGHT SIDE:15f2 LEFT SIDE: 111V -
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[X NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL fA COMMERCIAL [ ] INDUSTRIAL
[>Q OTHER (SPECIFY) CNoRCL4
13. DESCRIPTION OF PROPOSED USE: La/-lu/2CH
14. SQ. FT OF CONSTRUCTION: Sr 15. SF. FT 1st FLOOR: -f r &.2 F. 5/y 3r
C-'
16. VALUE OF CONSTRUCTION: $
The value of construction is used to determine the mount of permit fees to be assessed. SL Lucie '
value of construction if it is demonstrated that the submitted figures are not consistent with similar Iauls Reaves - (386) 679-0486
RECORDED Notice of Commencement must be submitted with this application. -
SLCCDV Form No.: 001-02 StEWARDSHIP SERVICES
' BUILDING CONSULTANTS, INC.
937A Meadow View Drive
.. - Port Orange, FL 32127-• -
Ministry in Church Facility Stewardship
E-mail:Innis@Churchconstruction.org
Fax (386) 760-9560 Web site: www.churchconstruction.org
r
OWNER INFORMATION
NAME: GzgCF FA-iA 4Rti+ w (Z • C Alf /.4 .G
ADDRESS: 0C-20 /�r1Fi=,y�,a /20-,�
CITY: tO.:ST. Ar,411 STATE: ZIP; 3/19Sz
PHONE (DAYTIME): ?( ZL) _33 7- L go }2/ Email: 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): (_)
CONTRACTOR INFORMATION
STATE: ZIP:
ST. of FL REG.CERT #: C SC- 0!5'9 -/ JR2 ST. LUCIE COUNTY CERT #:
BUSINESS NAME:. STE[ust.�.�`IPS�CIJtCt R /3u/ttliws CouSvcTaTsi1 �C
QUALIFIERS NAME: =l1rN/S A - �ZE.9ttt- S
ADDRESS: 937 A AI SAAot a6 aLrc c.o DlG: '
CITY: Fag,— STATE: F4oeL1bof ZIP:
PHONE (DAYTIME): dgU 679 -egg(. • • FAX NO..3?4 - 7Go -gSbo Email:
ARCHIT/ENGINEER:- *-5&ANJ VbSu G� —72r—j .
ADDRESS: .30 R$ be-V-V
CITY: OS%�EN STATE: 2L1J.G12:>44 ZIP: 32-74 Y
PHONE (DAYTIM[E): (*, 330 —3m r/2
B ONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
"A
029
h:
IMTORTANT 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.
4 �
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CERTIFICATION:
This application�is hereby made to obtain a permit to do the work and installation- Wlicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has conmaenced 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, TANS,
AND AIR CONDITIONERS, 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: 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 will be done in compliance
• /j p with all applicable laws regulating construction and zoning.
OWV�NTRACTOR SIGNATURE ONE L TRACTOR SIGNATURE
STATE OF FLQrj,?1 , �
COUNTY OF I'(JfQ ;
The foregoinginstrumentwas acknowledged before
me this —2 day of 2010--,
by :J_x�L 61e,ayes
STATE OF
COUNTY O 1 ID + x- �,,
6e
The foregoing instrument was acknowledged before nt
me this day of l r A 20 t o
by '1 QPAUQS
whoispersonally known _ or has produced who is personally known _ or has produced
0 t' ICrI dQ 11 6 06 Uiklrl ,P- s identification. �W i Wf S U GUtIcne- as identification.
t Qotary y
Commission No. Commission No. al)E
BALE
SyYol
.� MYComm Expires Aug8.i0fo ' DO Mm
NOTE: TWO (2) SCES� E H SIGNATURE MUST BE NOTARIZED.
THIS B II DER, 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 OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.