HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY - ZONING COMPLIANCEBP #-r-70IIIAea99,'
OFFICE USE ONLY
SECTION:
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TOWNSHIP:
RANGE:
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MAP NO:
ZONING:
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LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP#:
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
.I
I
;
03
WATER:
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SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACTFEE
IMPACTFEE
FEE
REPORT
CODE
PUBLIC BLDG
IMPACT FEE
HABITABALE
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RADON FEE
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GROSS ROAD
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACTFEE
IMPACT FEE
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DUE
323a.$O
Y
N
SCHOOL
CREDIT
TOTAL
IMPACTFEE
SCHOOL
IMPACTFEE'
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
77
MISC. FEES
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TOTAL ALL
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DATE
COMPLETE
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INITIALS
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-
UFFICE..USE ONLY
DATE FILED: Q qQ
PLAN REVIEW FEE: /,%0. 00 RECEIPT NO.: Z&V5 /�q PERMIT NUMBER:
,CONCURRENCY FEE: RECEIPT NO.: CERT CAP NO •
\ ALL INFO MUST BE COMPLETE 8t FILLED IN TO BE ACCEPTED
�\,rv16 COGy.� ST. LUCIE COUNTY PUBLIC WORKSL-�o
e
�p/ n BUILDING & ZRNIN DEPART �tw
'20RIOQ v v FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORNI•:r,Ti:'..
LOCATION/SITE ADDRESS:
` 2. S/D NAME:
3. PROPERTY TAX ID #:
4.
LEGAL DESCRIPTION (attach extra sheets if necessary):
SITE PLAN NAME:
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
{"�" Sog.lSx z3,�•o'x �z�.� x zz,zo x
S. PARCEL SIZE: ACRES/SQ FT. Z, 79 LOT DIMENSIONS 7-I3.ZZ -
10. D NSTRUCTION PROJECT OR WORK A TIVITYI _ N/SUG� Cl (/�� ' I I
.�'1.0� �(� `C (ems �f� G/�l,Ir 1. fll'�(� Q'`�^l�tt��
11. SETLLBAC AL) FRONT: / BACK: r RIGHT t LEFTV Cy
_301 SIDE 30-4Z SIDE: 7G1 �8
r ( appropriate boxes)RHN
12. TYPE OF CONSTRUCTION Check all
_1 NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ INTERIOR RENOVATION
6 [ ] RESIDENTIAL [ ] COMMERCIAL INDUSTRIAL
(] OTHER (SPECIFY) nn I
13. DESCRIPTION OF PROPOSED USE: f V `QC YI I ri p skop
14. Sq. Ft./CONSTRUCTION: 6 i 15. Sq. Ft. 1st Floor: Zim KA-t7
i6. VALUE OF CONSTRUCTION: $ ZcT
The value of construction is used to determine the amount of permit fees to be assessed. SL Lurie County reserves the right to question And/or modify the
indicated value of construction if it is demonstrated that the submitted figures are not cofsistent with similar types of construction activities. If )he value is $2500
or more, a RECORDED Notice of Commencement must be submitted with this applimilon.
SLCCDV Form No.: 001-02
OWNER INFORMATION -
NAME:
ADDRESS:
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: D Cni he- r-
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REGJCERT #: -7Gr�G 1(�}
BUSINESS NAME: K,C�� C,d r�
QUALIFIERS NAME: I�'r5 C lac, Y I
ADDRESS:
CITY:
PHONE (DAYTIME):
ARCHIT/ENGINEER:
nDDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
-ITY:
NORTGAGE LENDER:
\DDRESS:
:ITY:
STATE:
ST. LUCIE COUNTY CERT #:
:ons`f Cad'.P
ZIP
1-, P?F -Q.ac STATE: _ Y�,�{Cr��i ZIP
f 1 4T I — 033✓e- FAX NO. _ 415— 766
STATE:
ZIP
STATE: _ ZIP
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 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.
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
with all applicable laws regulating construction and zoning.
OWN R/CO TRACTOR SIC�I ATU
�I
STATE OF FLORIDA
COUNTY OF sr L U f; I I.
The foregoing instrument was acknowledged
p before me this nay of v)IL�c" , 20LQ I , by IRQaV(.
l�� Qakl2`�a, who is personally known to me or who,
has produced as identification.
Signature of Nota
VAN Sow6ke-1
r' Type or Print Name of Notary
Notary Public Title
IMPORTANT NOTICE: When a permit is issued and it is not picked up within GO days
after notification it will be voided and returned to you by mail.
CONTRAC OR SIGNATURE
STATE OF FL gI A
COUNTY OF t VOC
The foregoing In§`rurent was acknowledged
before me this LY!"day of 'De , 20 01 , by
, who is personally known to me
or who has produced as identification.
�S
S gnature of Notary
VAQ So W E(2_A3'1
Type of Print Name of Notary
Notary Public Title
h( 03 ommission Number PO 30 13�� Commission Number
;;; Van Sowerby
(Seal) g MYCOMMISSION& DD0313M DxPIRES Van Sowerby
June 4, 2005 (Seal) ate'
^' MY BONDEDTHRUTROYFAININSURANCE INC jAE r COMMISSION$ DD031360 EXPIRES
•o?„gGXt�`'� a•, June 4, 2005
%%""x BONDED THRUTROY FAIN INSURANCE INC
NOTE: TWO (2) SIGNATURES 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.