HomeMy WebLinkAboutApplication for Building Permit Certificate of Zoning ComplianceDATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: �YI{�J PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County Building and Zoning
- 2300 Virginia Avenue -
C3R1D - Ft. Pierce, FL 34982-5652 .
772-462-1553
it -_
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 2706 AL 25
2. S/D NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary): _ _fie J 1�fJ Zi Ce9L �l�
&L< 7 ,La TS 14 - 1 s� e3 -7PS
5. PLAT 6. PAGE 7. -BLOCK S. - LOT
BOOK NO. NO. NO,
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS s
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORD ACTIVITY: Vj//V Y4 •CB/'1`-? r V,4<AA
IL SETBACKS (ACTUAL) FRONT: BACK: RIGHT:
SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
] NEW CONSTRUCTION [ ] EXPANS1
[ ] RESIDENTIAL [' COM 1
[I OTHER (SPECIFY) SO T
13. DESCRIPTION OF PROPOSED USE: C C ALA
LEFT:
SIDE
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
14. Sq. FL/CONSTRUCTION: j 3� 15. Sq. Ft. Ist Floor:
A
16. VALUE OF CONSTRUCTION: $ 1��__� �l� rQ•sl`'
The value of construction is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonsltated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencetryent most be submitted with this application.
SLCCDV Form No.: 001-02
-•-w �"°y� :ate. � '
OWNER INFORMATION .
NAME: Z-% A.I,JC (&- Y
ADDRESS: 30 oa GU)el-e-' &C NG eLVID
CITY: lCeAcr 31 * Cd STATE: 1� ZIP 3/V-19
PHONE (DAYTIME): () 462--17'32 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: STATE: ZIP
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. of FL REGICERT #:
ST. LUCIE COUNTY CERT> #:
4,Z2
BUSINESS NAME:
CLFS'L!% (f4q
r &,u—tw 6m ✓iti
QUALIFIERS NAME:
/aieR N� A
L65C4 jY-Q
ADDRESS:
HLY0 107 tz
CITY:
STATE:
ZIP'
PHONE (DAYTIME):
(_) -'/0E--7v025"FAX NO
email:
ARCHIT/ENGINEER:
Spt� �t/Y
f7�K-�'l K ZK s
61'j ocmmg
- '6/'7ClC4L-y
/p o�'
ADDRESS: 3641E
ZN,011 'rl&.44
33" S-
CITY: .c%
STATE: r-'(— I
ZIP
344qA0e;6
PHONE (DAYTIME): (_S4f((
BONDING COMPANY:
ADDRESS:
CITY:
STATE: ZIP
MORTGAGE LENDER: yT .,
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 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 concurfency 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 zo ngr
ER/CONTRA OR SIGNATURE ONTRACTOR SIGMATURE
STATE OF FLO
STATE OF FLO A
COUNTY OF CIE
COUNTY OF, LllUt�
The foregoing instrument was acknowled$ ed The foregoing ins ment was acknowledged
efare1g thisoisda of 200"(by b fore me this-J day of /i 204by
Qylfi l LG✓iGf , wh is personally -- mK I e 'who is personally
known to me or who has produced known to me or who has produced
dasidentification. L�S3-/S''�7ia-(�sidentification.
atmeofNotary Si ature of Notary
Type or Print Name of Notary Type or Print Name of Notary
...Alf Dana Ward Y dU
Commissipll,j9NpD586672 DasWa t.#��
p Commis ' S M�6672
S, "•.: Expires
gust 20, 2010 •;
f, s Au ;+ , Expires August 20, 2010
,7,Y9onMOTroY fain-Inwnnce.IM 806999•T979 ,,�
BontlM Troyfnm inwrenca, inc 409.999.1979
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.
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
�fV'J
1
LAND USE
LOTCVG% -
TAZNO.
FLOOD ZONE
FIRM MAP #
ISTFLR ELV
MAX HC.T
CONSTTYPE
OCCUP TYPE
MAX OCCUP
#OFFLRS
WATER
SEWER,,...,-'
�d
4L(OT
SPRINKLERS
STORMWATER
LOT OF REC
I
LOT OF REC (after
SPLIT
I LOT SPLIT
ADMINST
-
LIBRARY
PARKS
PERMIT
-
VARIANCE
'IMPACTFEE
IMPACT FEE
FEE
REPORT
PUBLIC BID
HABITABLE
RADON FEE --
,CODE
IMPACTFEE
AREA
QLAD ON)
SCHOOL
GROSS ROAD
CREDIT
Y
- N -
- --TOTAL ROAD
IMPACTFEE
IMPACTFEE
IMPACT FEE
DUE
SCHOOL
CREDIT
N'
°r
FIN-TOTALY
-
IMPACTFEE
f"'
SCHOOL
IMPACTFEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES -
ADDITIONAL
Y
N SPECIFY
I
TOTAL
-
PERMITS
lofALL
REQUIRED
I
FEES
1 REVIEWS ZONING ZS
REV]
DATE
PLANS MISC. VEGETATION SEATURTLE MANGROVE
XAMTN/G