HomeMy WebLinkAboutZoning ComplianceDATE FILED
PLAN REVIEW FEE: IJ D RECEIPTNO.: ' PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
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9.
ALL INF MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County Building and Zoning
2300 Virginia Avenue
'r70R1D ` Ft. Pierce, FL 34982-5652
`\ 772412-1113
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SffF /ADDRESS:
/
S/D NAME: (/l�
PROPERTY TAX ID #:
LEGAL DESCRIPTION (attach extra sheets
SITE PLAN NAME:
PLAT 6. PAGE 7_ BLOCK
BOOK NO. ^42 33 NO.
r= D
8. LOT
NO.
PARCEL SIZE: ACRES/SQ FT. J / O --C- LOT DIMENSIONS 6301 X / / % o
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY�t/T��/
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11. SETBACKS (ACTUAL) FRONT: /BACK:
RIGHT: p r
9 SIDE /
LEFT:
SIDE /
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12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ J INDUSTRIAL
Q OTHER(SPECIFY)�=!'l/�ST�i'{%�/T
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13. DESCRIPTION OF PROPOSED USE: ��isF{C u S� s of hisc /3 c�nv o
14. Sq. Ft/CONSTRUCTION: leo L) / 15. Seq.. Ft I st Floor: 4 � S�_
16. VALUE OF CONSTRUCTION: $ / �UO U �C-aDgo
The value of construction is used to $etemune 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 demonslfated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commence0tent must be submitted with this application.
SLCCDV Form No.: 001-02
NAME:
ADDRE
CITY: f—oP-7- P/e-ACC-- STATE: FL- ZIP ' �3 V `% 114
PHONE (DAYTIME):u
(?Z& ! � F^ % 8 S O 402c 711 - 5I(e' $ - 73 1 9
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): Lam'
CONTRACTOR INFORMATION
ST. of FL REG./CERT ST. LUCIE COUNTY CERT #: oZ y
BUSINESS NAME: L ct - A �^ P S T p[ C?Z'/✓
QUALIFIERS.NAME: %iX�
ADDRESS: %9/�7
CffYVL��/ <9,, Os-75--w-l'f 'STATE: ZIP
PHONE(DAYTIME): (S(SSI �l�J�l�-%,�90 FAX NO. i"638`"80S4% email:
ARCHrIVENGINEER:
ADDRESS: YSJ ���T'^/T /-33/V
CITY: �Gi� 47?L) $
PHONE (DAYTIME): ({6i ) 776 - 6 // O
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE
ADDRESS:
CITY:
STATE: L-
STATE:
ZIP
ZIP
-';>5%/IY
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 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-
The foregoing ins�vument acknowledged
�b fore thi �1 yd2y of 1JPC , 20b by
� e f personally
known to meCp
CONT TOR SIGNATURE
STATE OF FLOPDA
COUNTY OF , L_0 G. -
The foregoing in ment 1� acknowledged
ore me $% ay of UFO , 20_g by
(140AV � who is personally
known to m
�p,Y PLC Debra . Guerra
z �� i:ommission # DD258474
W M7 Smded TfOY fain-ItuuredcE, Irc: BC03
o. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. ,EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNERAWILDER, 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.
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SECTION
"
TOWNSHIP
�!55
RANGE
MAP NO.
ZONING
TL
LAND USE
M XD
,'"�/`
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
G'
1ST FLR ELV
MAX HGT
CONST TYPE
3
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
1 R,ll-T
SEWER
w
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC (after
11190)REQUIRED
LOT SPLIT
LOT SPLTT
before 1/90)
APPROVED
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ADMINST
LIBRARY
PARKS
PERMIT
VARIANCE
IMPACT FEE
IMPACTFEE
FEE
REPORT
PUBLIC BLD
HABITABLE
RADO E
CODE
IMPACT FEE
AREA
(RADON)
SCHOOL '.
-
GROSS ROAD
CREDIT
Y
N -
--TOTAL ROAD
IMPACTFEE
IMPACT FEE
IMPACT FEE
DUE
SCHOOL
CREDIT
N
a.�
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
'..
FIRE FEE
MISC FEE
TOTAL
'..
',.
POLICE/FHRE
MISC FEES
�C%� +�f"
ADDITIONAL
Y
N
SPECIFY
p
TOTAL
PERMITS
{� a� ✓
of ALL
REQUIREDv
'lu/m
/��
FEES
REVIEWS .ZONING
ZONING PLANS. MISC. VEGETATION
SEATURTLE
MANGROVE
REVIEWED BY EXAMING
DATE
COMPLETE
INITIALS