HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - CERT OF CAPACITY - ZONING CAPACITY'OFFICE USE ONLY:
DATE FILED: -coy?
PLAN REVIEW FEE: RECEIPTNO.: PERM]7'NUMBER: / ".
CONCURRENCYFEE: RECEIPTNO.: CERT,%AI'._NO.�- --
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Aver.ve
Ft. Pierce, FL 34982--5652 Q'
772462-1553
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APPLICATION for BUILDING PERMIT tq�
CERTIFICATE of CAPACITY/ZONING COMPLI C IJ
PROJECT INFORMATION Cot/
I. LOCATION/SITEADDRESS:IQZ [L2iili5 gIV n5CA irm=V,,FL U9 1
2. PROJECT NAME: SITE PLAN NAME: _
3. PROPERTY TAX ID #:
4. LEGALDESCRIPTION(attach extra sheets ifnecessary):NJeilltS T,,(Q l,Tn}fit C(M 0-SfC�lan f1 �are!!�
142 nnrl an, -rota <i.are 1h Cara inert [em ede �ov 4 �4q)
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): /L%OT DIMENSIONS:
10. COMPLE E D(ESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: `C ) �L r-'C
11. SETBACKS (ACTUAL) FRONT: W-0 BACK: `Jt St
_ RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ j INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. t5Q. FT OF CONSTRUCTION: 1053 15. SF. F: 1st FLOOR: I cb3>�
16. VALUE OF CONSTRUCTION: S 10 �j"
The value of construction 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 of construction if it is demonstrated that the submitted figures are not consistent with similar types of coestuction activities. If the Value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 625/09
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OWNERR INFORMATION
NAME: Rdocy+ ti- EII?gbc�h r�P�ciev� n
ADDRESS: I1q PMSrOCC+ AVC
CITY: 10*--SIpureh _ STATE: ZIP:
PHONE (DAY (DAYTIME): Email: b�Fs�gSIC[4S�IQc�l.C6M
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): �)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: (%Sgti 12 ST. LUCIE COUNTY CERT #:. 'Z, 36$ O
BUSINESS NAME:
QUALIFIERS NAME: MO.0
k "q%S
ADDRESS: 169 (.-1 S O CCar% 0 v
CITY: JC1LNsen l3eacy, STATE: FL ZIP: 3y�51
PHONE (DAYTIME): (l92)27R-RK34 FAXN0.172 9•9CHO Email: Mn[1C/amCl'Y�raYt1
ARCHIT/ENGINEER: =- YU e yiY.sw -e \
ADDRESS:
CITY: S y 6�-}— STATE: ZIP: `
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY: STATE: _ ZIP:
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: 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-permitand.that all
work_ will be erformed to m_eet_thestandards-ofall-laws-regulating-construcho`n in this junsdiction. I understand that separate permits
ntay 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.
OWNEKOR CONTRACTOR SIGNATURE
STATE OF FLORIDA 1
COUNTY OF
The foregoing instrument was acknowledged before
me this J-- day of20 1�
by Mcv,
who is personally kno—i or has produced
as identification.
Signature of Notary I I 1?
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CON RACTORSIGNATURE
STATE OF FLORIDA �� ll�
COUNTY OF
The foregoing instrument was acknowledged before
me thiissr�1— day yof
/ , 20 13
by I�IG Itl�
who is personally known-' or has produced
as identification.
Signature of Notary
Commission No. a DAVID .'RR�PPER Commission n,.•^n : Lirmes
ID N, IWEIfB�)
Commission9,1 995518 =.: isSlon{hDD995$16
a Expires September 25, 2014 � September 25, 2014
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NOTE: TWO (2) SI ATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILLBE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ®NLI BP #: D
SECTION
TOWNSHIP
RANGE
MAP NO.
- -
ZONING
LAND USE
`T% � L —
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LOT CVG %
I S .55
TAZNO.--
FLOOD -ZONE
Y1fi /„'
FIRM MAP#-
1ST FLRELV----MAX-HGT_----------
CONST TYPE
OCCUP TYPE
MAX OCCUP
_
_# OF FLRS
I
—
-WATER
-SEWER-- - --
-
- --
-SPRINKLERS
- _ --
STORMWATER -_--
-- _ --
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
CODE
O
Ok
�AABLE
RADON
FEE
ERM rr
F F
LIBRARY
IMPACT
FEE
PUBLIC BID
IMPACT FEE
CORRECTION
PUBIC BID
FEE
PARKS
IMPACT
FEE
GENERAL
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
IFEE
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
COTJN-Mk
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVXW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
RECEIVED
lei
DATE
-COMPLETED
II�T1T'IALS