HomeMy WebLinkAboutApplication for Zoning ComplianceOFF�Cli USE (,)NLY: C Q
DATE FILED:'
ILED: ��
PLAN REVIEW FEE Lv
0- RECEIPT NO.: �1� 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
R} Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PVRMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 6p50 I I�cn�� n� J ✓
�(.. Qu. (: G-
2. PROJECT NAME: So 11 F� + '� Cow z h h SIo6TFnE PLAN NAME: SP
3. PROPERTY TAX ID #`. �f o l ' 13`f -cvo3 —0/0 - !r
4. LEGAL DESCRIPTION (attach extra sheets if necessary): Pt 4AAma4 a
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
lease. area
9. PARCEL SIZE (ACRES/SQ FT.): • 1'!)l I�"' LOT DIMENSIONS:
ioioco
10. COMPLETE DESCRIPTION OF CONSTRUC1TION PROJECTOR WORK ACTIVITY:
:5,a -S p^iaL,
go
it. SETBACKS (ACTUAL) FRONT: ti 10 t BACK: RIGHT SIDE: LEFT SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[4 NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE
14. SQ. FT OF CONSTRUCTION: tb,_n0 0 _ 15. SF. FT 1 st FLOOR:
16. VALUE OF CONSTRUCTION: $ h n/ o v
The value of con**tion 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 constmcrf 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
RECORDED Nca�Fof Commencement must be submitted with this application.
SLCCDV ForrpiNo.: 001.02
• 3r
OWNER INFORMATION
NAME: ---V Cp A SV • �,,-% 4 _ LLC. (/
ADDRESS: O ou
CITY: O✓javn STATE:7(X ZIP: "?�7OSG
PHONE (DAYTIME): (&I SS/- oo/'1 Email: SSej Q LiC/3-0-e "A A. c 6.
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 #: ST. LUCIE COUNTY CERT #
BUSINESS NAME: L S S WdLLtti C oi0 r I '- -
QUALIFIERS NAME: Sa,M L, e-I p r
ADDRESS: 24O� Rzcscya Dom' c
CITY: \ /s r. L5e A,�6 STATE: (' L ZIP: 3 3 iy S
PHONE (DAYTIME): Q(Qj FAX NO. Email: SGnc' n 6 Q Mm, G , .
'Z11z
ARCHIT/ENGINEER: NAIR&� , i-. r• ( -,
ADDRESS: jztqj C .+er .cow_
CITY:
PHONE (DAYTIME): 4'40) A!{'d' 3G(L
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE: �K Y ZIP: `fzo CB
STATE:
ZIP:
W.
IMPORTANT N !ICE: When a permit is
it will be voided alll returned to you by mail. issued and it is not picked up within 60 days after notification
STATE:
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 A]
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permiN
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.
�N+�
OWNER OR CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLORIDA ,/) ) lC
COUNTY OF Q
The foregoing instrument was acknowledged before
me this _ day of � -nL 2a. 6sL
by t8
who is personally known _ or has produced
as identification.
)i
;Sign4aturofotary
STATE OF FLORIDA�/O�/
COUNTY OF 4
The foregoing instrument was acknowledged before
me this
/� day of —, 20 �L
by JLhN �l
who is personally known or has produced
as identification.
����7a Sv^--.rF- CiCIIiY BARNA
1 KYLE E FRY Com fission No. co dwu(Ik nosaas a
Commission No.13 MV COtiM1ISS" M [mn MS �''Furn''e 6r rtaes: ntrc. u,mto
"NRES May 11, 2M2 (mr)sseoie3 noddaNOWYSe 00.WM
FlatdaMo4iy8Mrlt+tma
NOTE: TWO (2) SIGNATURES ARE REQUIRED, EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING R
N
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO S1
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION,
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist,
I
OFFICE USE ONLY BP #: 0 -
SECTION
TOWNSHIP
cJ1
5 5
RANGE
�Q�
•w
MAP NO.
Kam/
ZONING
LAND USE
VI t
�,f
LOT CVG %a
TAZ NO.
FLOOD ZONE
FIRM MAP #
'1 �(1
dy
IIT FUR ELV
MAX HGT
CONST TYPE
J /
(f
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
�' O�
HABITABLE
AREA
(RADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEEON
CORRECTI
UBIC BLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENE
IMPACT
FEE
-
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC _ ROOF _
ELECTRIC GAS _
PLUMBING _
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES tl V
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
INITIALS