HomeMy WebLinkAboutApplication for Building Permit Certificate of Zoning ComplianceDATE FILED.
PLAN REVIEW FEE:
CONCURRENCY FE
1.
2.
3.
4.
RECEIPT NO.:
RECEIPT NO.:
PERMIT NUMBER: O
CERT. CAP. NO.:
ALL I FO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
h St. Lucie County Building and Zoning n
2300 Virginia Avenue
F<ORIO Ft. Pierce, FL 34982-5652 p
772-462-1553
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APPLICATION for BUILDING PERMIT
CERTIFICATE o�fyvCAPACITY/ZONING COMPLIANCE
PRO E f j FTAT19N !
LOCATION/SITE ADDRESS:
S/D NAME: _ SITE PLAN NAME:
PROPERTY TAX ID# (! — V Y 3 — O Q O!—
LEGAL DESCRIPTION (attach extra sheets if
.. _ . . n
l d 11 -Y
5. PLAT ��� - LLL 6. PAGE v 7. BLOCK 8. LOT U
BOOK NO. NO_ hr l9 '' " NO.
t�
9. PARCEL SIZE: ACRES/SQ FT.., LOT DIMENSIONS C� . 3 C�.: �Ci %I 7 D _
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WOU ACTIVITY: tx ,,CJ GJ
4111/iF'r-
1 1. SETBACKS (ACTUAL) FRONT: Q ,ABACK:/ RIGHT: r LEFT: .
SIDE _ `T SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSIONIADDITION [ ] INTERIOR RENOVATION
[] RESIDENTIAL [I COMMERCIAL } DUSTRIAL
OTHER (SPECIFY) SM AEj�'JL
13. DESCRIPTION OF PROPOSED USE: h (A$
14. Sq. FL/CONSTRUCTION: 4 15. Sq. Ft. 1st Floor: /
16. VALUE OF CONSTRUCTION: S D
The value ®f 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 rebsruction 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
RECORDPD Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
NAME:
ADDRESS: — !
CITY: tt�LATE: �— ZIP
PHONE (DAYTIME): ( '�' — fL : 27 2- g 73 046
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW. , /
FEE SIMPLE TITLEHOLDER: ,/`/' L/� /
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME):
V
CONTRACTOR INFORMATION pp
ST. of FL REGJCERT #: LU>C O ST. LUCIE COUNTY CERT #: 1 6 O 9
BUSINESS NAME: �C-
� A QUALIFIERS NAME: ��v k AJ,T-A-te'F—b
ADDRtE'SS: 7 C Ot
CITY /2 STATE: L i. ZIPU / -
PHONE (DAYTIME): (S'6I)AAA g -f-7 yJ FAX NO At — 6 30 `p 0S email:
ARCHIT/ENGINEER:
ADDRESS:
CITY:iM &Ark �r��gTL/J 5 STATE: F ZIP 33 / o
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
V J STATE:
ZIP
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.
0
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
TQ 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.
4 OWNE NATU
STATE OF FLORIDA
COUNTY OF S% LLA-C i e
The foregoing instrument was acknowledged
before Me this 7 day of Fe—h , 20 7 by
ho is personally
known to me
ae idenEt€ieation.
�,// CONTR4CTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF ! ' L.t L c t e� t - _
The foregoing instrument w�s appknowled&ed
before me this fo day of ir''�i`l , 20 0 , by
f(1.ftV K , who is personally
known to me wA4i herprodlreed
Ignature o o ary Signature of otary
Ty L"AilIM111 Type r�T@9'@I�MW INGRALDI
C E R�� INGAI,DI MY COMMISSION♦DSEIII)3
lI``�I �1==yy CO IIS EXPIRES: May 3�fll)
6
EXPIRES: MaY 31.2010 (407)SWIM AWdON*WYS-Mma
(4mgmiss FW&Nm YSaMa ....
N WU(2ySlG A REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING ftOR
THIS BUILING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO S'I<iGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.
tea.: 3a:FY `
SECTION
?- t
TOWNSHIP
RANGE
MAP NO. aws
sJt
ZONING
�.
LAND USE
LOT CVG%
TAZ NO.
FLOOD ZONE
FIRM MAP #
IST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
X OCCUP
# OF FLRS.
WATER
..SEWER
SPRINKLERS
STORMWATER
LOT OF REC
-
'LOT OF REC (after
LOT SPLIT
LOT SPLIT
before 1/90
1/90)
REQUIRED
APPROVED
'�
ai' ..W'iF
ADMINST
LIBRARY
PARKS
PERMIT
VARIANCEIMPACTFEE
IMPACTFEE
-
FEE
REPORT
PUBLIC BLD
HABITABLE
RADON FEE
CODE
IMPACTFEE
AREA
_
(RADON).
SCHOOL
GROSS ROAD
CREDI
Y
N -
-TOTAL ROAD
. IMPACT FEE
IMPACTFEE
IMPACT FEE
..
DUE
�
` SCHOOL
CREDIT
N
`"'v-_
TOTAL
IMPACTFEE
SCHOOL
O
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL Y
N
SPECIFY
-
TOTAL
PERMITS
of ALL
REQUIRED
FEES
Ski M^-�k•
REVIEWS
ZONING
ZONING PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
,......
_.,:--.
REVIEWED BY EXAMING
DATE
COMPLETE
INITIALS t""