HomeMy WebLinkAboutBUILDING PERMIT - CERTIFICATE OF CAPACITY - COMPLIANCEOFFICE USE QNLY:
DATE FILED oN
PLAN REVIEW FEE: RECEIPT NO.:
1 PERMIT NUMBER:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft: Pierce, FE 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT ` l/J-rw E
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION OW FvaCOO
1. LOCATION/SITE ADDRESS: 5tl nl ?1 C 7L 314 �G�tn7viai�
2. PROJECTNAME: A- S) ar „ , SITE PLAN NAME: RY
3. PROPERTY TAX ID#: UUZZ Rtn min - ocn St. LUdeCoun'
4. LEGAL DESCRIPTION (attach extra sheets ifnecessary):'7i �, . P� �',11 a �� to v6 e . _2; 1 '
PLAr as 45ic 31 P� tz-t2L5 �-
5. PLAT BOOK �9 U 330 6. PAGE NO. t? - m3 7. BLOCK NO. 8.. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): . 9 gA e- _ LOT DIMENSIONS: . `] 6 A c,� s
10.' COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
FAG �i tl'Af 9
11. SETBACKS (ACTUAL) FRONT: _p��S �ACK . O RIGHT SIDE: 1S 08 LEFT SIDE: gk in. -i
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ PW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL,
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE. Si n c L
14. SQ. FT OF CONSTRUCTION. 15. SF. FT Ist FLOOR 3 y oa
16. VALUE OF CONSTRUCTION: S I a -( 1. 9 -13. s Z
The value of construction is used to determine the amount ofpermit fees to be assessed St Lucie County reserves the right to gdcstion and/or modify the indicated
value ofeonstruction if it is demonstrated that the submitted figures are not consistent with similarrypes of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6r25/o9
OWNER INFORMATION
NAME:
ADDRESS: a2 1 U u c I k
CITY: STATE: FL, ZIP: Z -1 9 9 1,
PHONE (DAYTIME): (2D7) 3-70 - -71 9 3 = Email: JL,, L L cm
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: ti.,
ADDRESS:
CITY:
PHONE (DAYTIME): L—)
CONTRACTOR INFORMATION
STATE:
ZIP:
ST. of FL REG.CERT #: CAC I Sa3 S S ST. LUCIE COUNTY CERT #: cP Z S- -7-7
BUSINESS NAME: (�) U. e L e A •%n C
QUALIFIERS NAME: l a 1
ADDRESS: >g, P.o. box 152S-1
CITY: Yer � Sa 1....,. o STATE: _FL ZIP: 3
PHONE (DAYTIME): -77z22 3 oe� 014 FAX NO. -m z 2 z 3 o 6 94 Email:
ARCHrf/ENGINEEIL- ✓n l 1. 1) A
ADDRESS: '-I o n 1v C+ pr4 5 c i� w slt z l
CITY: 1 � 4 , . , t Ln STATE: r C- ZB': 3 3 q(- y
PHONE (DAYTIME): (WW2') S-c_ 19 5 cl
BONDING COMPANY: f,3 e-
ADDRESS:
CITY:
MORTGAGE LENDER: ►-3 .
ADDRESS:
CITY:
STATE:
STATE:
Mr
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
if apulicable, for the permitted work. I certify that no wnrk-orinstallation has -commenced -prior -to the issuance of-a-permil
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: YOURFAILURE 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.
SCANNED
�� St. Lucie County
OW14ER OR CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF Fl
COUNTY OF
The foregoing instrument was acknowledged be e Q < b
Poo
2 s 3 a
me this 01 day of
20 o y m
by ZVPrr}
R arA v5
m=
who is personally own
or has produced '.
as identification.:
Signature of N ry
Ly t/UVT a
V"
zm�a
�z
Commission No.
(Seal)
STATE OF FLORIE A ./ /
COUNTY OF J f .Zkae
The foregoing instrument was acknowledged before
me this day of 20 /) ,
by I)e V A'%JAYq L u
1 '
who is personally own or has produced
as identifl tion
SiginffuremNotary
Commission No.
(Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. NATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNS THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED E FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERIBUH.DER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #: J 1 b 7• d�G, `�
SECTION
1/
TOWNSHIP
ol� S
RANGE
a�
MAP NO.
r 7 9A
ZONING
1 ^
�V l
LAND USE
yl
v�l
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
ISr FLR ELV
HGT
CONST TYPE
OCCUP TYPE
CCUP
# OF FLRS
— —
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
OF REC
LOT SPLIT
LOT SPLIT
Before 111990
After 111990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
m
' V 1
AREA
FEE
FEE
LIBRARY
PUBLIC BID
PUBIC BID
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC_ ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
_
ELECTRIC _ GAS
LOT OF RECORD `• '
FEES
REQUIRED
PLUMBING _
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
ci
DATE
COMPLETED
INITIALS
OFFICE USE`.ONLY
SECTION
:/-
(,
TOWNSHIP
C
RANGE
7o
MAP NO.
T Jaa S
ZONING
1[�
(�,
LAND USE
�J
LOT CVG %a
TAZ No.
/
FLOOD ZONE
FIRM MAP #
j I j
1s'r PLR ELV
MAX HGT
r I
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
„ n
191�1��/
SEWER
n- - ,., n
lLJ�7LU SLOT
SPRINKLERS
STORMWATER
LOT OF REC LOT OF RFC (after SPLIT LOT SPLIT
(before 1/90) 1/90) REQUIRED APPROVED
D� s f
ACRY
-/3'
PARKS
gy �b
MIT
FEE
VARIANCE
RAPADMINST
TFEE
IMPACT FEE
REPORT
c,
PUBLIC BLD
IMPACTFEE
aLI 15.63
Fr
HABITABLE
AREA
RADON FEE
CODE
1 as
.
(RADON)
SCHOOL
y y�
1 ' X
GROSS ROAD
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
IMPACT FEE
$tp DD
IMPACT FEE
DUETT
I
+
SCHOOL
CREDIT
TOTAL
�.
d �-.,
r =�S^'
IMPACT FEE
O
SCHOOL
IMPACCTFEE
d
POLICE FEE
FIItE FEE
�' =
� MISC FEE
'I6TRL„r
�Ao
�83.°b
Em S
1494,00
-
MISCFEESS
4a-7G6c7 it C.
ADDITIONAL
Y
N
SPECIFY
�G
TOTAL
/
PERMITS
REQUIRED
�dc.F L ?
of ALL
FEES
REVIEWS
ZONING
ZONING
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMING
V L 4!5--
DATE^nr V
�° %D%
tDj12� ID�
7117
99 473
7P,31 7
orrrxk;r.t�.�n viva,,x:
DATE "FILED: S �� U7 /
PLAN�VIEW-FEE: - a- REC-EIPTNO.:y RiuT-NU1viBER-----
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:Q
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEP lT6lE1,D/,
SCANNED
St. Lucie Count Buildingd Zoning BY
ang St. Lucie County
V
2300 Virginia Avenue
Ft. Pierce,-FL-34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
Slj,w:n�
1.
LOCATION/SITE ADDRESS:
1-0+ LT- S-i tn.e.r v t l I Lxay Yai
J`j'1'7V
2.
S/D NAME: IA ^ehoue Z• Au.
SITE PLAN NAME:
3.
PROPERTY TAX ID #: 2a
32 - cg 10 - Go 10
4.
LEGAL DESCRIPTION (attach extra sheets if necessary): All e A L 4 Cr , as sl
0 p I 11
9..b...
1 w>a xo �cerd
1
I' P1a1U 3l P4�Pu61•�-Zd5
e-C 54 I c'
Co
5.
iosol
PLAT 6. PAGE 7. BLOCK
1 2-1
8. LOT
BOOK_ NO.
NO.
NO.
9.
PARCEL SIZE:.ACRES/SQ FT.
O- to 3 LOT DIMENSIONS o7� t • t 1.
I
l S'1 .. 9 !�
I
sa,0ao. n
10.
DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
I
x,Ft.,
as+ojz4 ::�9Z,42eom L j-a R.44,,i
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT:
,,,--BACK:
S I SIDE t$ SIDE. I S-
as,oa
12. TYPE OF CONSTRUCTION (Check all appropriate bo es)
L4. NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ 1, INTERIOR RENOVATION
JQ RESIDENTIAL (] COMMERCIAL [ ] 'INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: �a„� :1.. t
14. Sq. Ft./CONSTRUCTION: is V- � 7` 15. Sq. Ft. ls[F]oor: 078 ?-(
I _s1
16. VALUE OF CONSTRUCTION: $ Co SU , 6o O o0
I The value of construction is used to determine the amount of permit fees to be assessed. SC Lucie County reserves the tight to question and/or 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 $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
CERTIFICATION:
OWNER INFORMATION
NAME: �( ; GA n uc
+- ,nev tC,ve
ADDRESS: t3S C3 3 CaQpelu. -
CITY: PG.X � C � — STATE: f L ZIP
PHONE (DAYTIME): (1"12-) 81t a a 9 9 email: A
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER: tzr A
ADDRESS:
CITY: STATE:
PHONE (DAYTIME): (�
CONTRACTOR INFORMATION
cT of FL. REG./CERT #: e3L 12 S a 3 8 8
BUSINESS NAME:
QUALIFIERS NAM
WQ
ST. LUCIE COUNTY CERT #:
ADDRESS: (. 5E, 1 e� t ca 3y g
CITY: 5 � �' STATE: ZIP
"� 7d3-`A1SC email:?. -.a tLEv/ on
PHONE (DAYTIME): 7. 2) �� 3 O<-O� FAX NO.1-1d
Fc Ce+5 —
CA M
ARCHIT/ENGINEER:` V i Ili+. A r k. AtA
ADDRESS: e-IO
STATE: � C ZIP
CITY: -l'i 4d
PHONE (DAYTIME): �) �'q3 - 44 S 9
BONDING COMPANY:
ADDRESS:
CITY: . STATE: ZIP
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
09
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.
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, 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.
NT
RESULT IN YOUR
NOTICE TO OWNER: FAILURE INGWICEFOR IMPROVEMENTS TCORD A NOTICE OF O YOUR PROPS 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, TIME,
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
1 applicable laws regulating construction an g.
/lwiTI A1111 CT!-ST.TeTTTRF ~_�.Y�= CON ACTOR SIGNATURE
RE
STATE OF 1 w STATE OF FLOR]
COUNTY OF J �$ COUNTY OF
Lknoed
N a The foregoing instrument was acknowled ed
The foregoing i strument was a- �, as.• $
o s :;t. _1 efore me this ' day of 20 ° /by
efore me [his da o w zya= M who s personally
w o N ooknown tom or who h s pro as s s m� co to me or who asproduced
as 9 J �m �' CJ as ident fication.
m w z =
9
Signature of Notary � - � ignature of otary
Type or Print Nar4e of Notary Type or PrintName of Notary
Commission No. (Seal) Commission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNERBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.