HomeMy WebLinkAboutZoning ComplianceDATE FILED: 4�
PLAN REVIEW FEE: RENO.: PERMIT NUMBER: 97600 l-50
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: `
a
ST. LUCIE COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
2300 VIRGINIA AVENUE, ROOM 201
FORT PIERCE,, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIAAN�(CE ��A
P 5 L _-�� Z&Q
PROJECT INFORMATION 34gg*7
1. LOCATION/SITE ADDRESS:' 9 01
2. S/D NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT
BOOK
6. PAGE
NO.
9. PARCEL SIZE: ACC RES>� FT.
010
SITE PLAN NAME: C
BLOCK 8. LOT
NO.
LOT DIMENSIONS C5 / 31t
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: _
11 VBACKS (ACTUAL) ONT: / A : / RIGHT G l LEFT /
/p �J/5 SID /G ID
12. TYPE OF CONSTRUCTION (Check alll apappropriate boxes) �
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL_ [ ] COMMERCIALINDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED: C A'' 7i ry fiiYl,0wi
�l9G;�r7y
14. Sq. Ft./CONSTRUCTION: �� �/ 15. Sq. Ft, 1st Floor:
16. VALUE OP CONSTRUCTION:. 3121 �D • cC;
The value of 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 construction if his demonstrated that !he submitted figures are not consistent with similar types of construction activities. ifthe value Is $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
ST. LUCIE COUNTY
APPLICATION for BUILDING PERMIT
SLCCDV Form No.: 001-02
ST. LUCIE COUNTY
APPLICATION for BUILDING PERMIT
OWNER INFORMATION: �• I �'�
NAME:
ADDRESS:
CITY: ` Z A4 U/20 R'17k14C-/ STATE: "r % ZIP -73
PHONE (DAYTIME):
i
� IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) I DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: ..�-
ADDRESS:
CITY:
C�� ` � ` -ZAP J}33l
PHONE (DAYTIME): f / 9'� � f '5 71 :J:(f -"
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: f d� L,/��lv L ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
n _ % _rl„ _ i .✓l 7
ADDRESS: _
CITY:
PHONE (DAYTIME)
ARCHITfENGINEER:
ADDRESS:
';. CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
[9Y1!
MORTGAGE LENDER:
I- ADDRESS:
CITY:
STATE:
STATE: F-L ZIP
STATE:
MW
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.
ST. LUCIE COUNTY
APPLICATION for BUILDING PERMIT
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 R 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 NOTYOUR 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
f
all applicable laws regulating construction and zoning.
SIGNATURE
STATE OF FLORIDA
COUNTY OF ✓,S o41A i
7 The foregoing instrument was acknowledged
before me this Z2 O day of/4uCuJ719_kl by
C'id/�cK t.� 11,.I'X , who is personally known to me or
who has produced as
identification. '
i'
Signature df Notary
/O!✓s� �
Type or Print Name of Notary
STATE OF FL
c
COUNTY OF
The foregoing instilment was ackn wled ed
befo a thi;Lj day of 19_,
by, u Is pe onally known
to me or who has produ
identification.
Signature of Notary
Type of Print Name of Notary
Notary Public Title Notary Public Title
e4CS70J6C1 Commission Number Commission Number
i �A�r/•,wvvwwJ.NN+vt,
(seal) Not„Y,LOUIS P DIVITA .f (seal)
�Stote or Florid*
Pubtla \ MV Comm. Expi10163M4
y''✓�� ���� Comm#; CC64M" j
NOTE: TWO (e ED. 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.
ST. LUCIE COUNTY y
APPLICATION for BUILDING PERMIT
BP #c
Y
RANGE:
MAP NO.:
/
TOWNSHIP:
��
rio
ESECTIOW,
°b:
/
TAZ NO.:
I(�
LAND USE:
LOT CVG
FLOOD ZONE:
X,
FIRM MAP #:
1ST FLR ELV:
MAX HGT.
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
/
WATER:
SEWER:
�(!"�'
SPRINKLERS.
STORMWATE
r/ �l I
R
LOT OF REC (be(,
1/90)
LOT OF REC (aRr
1/90)
LOT SPLIT
LOT SPLIT
-
REO'D -
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
CODE
22
PUBLIC BLDG
IMPACT FEE
/��1r�'Oo
/'�
HABITABALE
AREA
RADON FEE
C5
(RADON)
ROAD
GROSS ROAD
/J
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
//I,
IMPACT FEE
DUE
SCHOOL
-
CREDIT'
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
N-`
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
J
-
FEES.
REO'D
REVIEWS
ZONING
ZONING
PLANS
Ti;-
VEGETATION,
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMINING
DATE
COMPLETE
(�
INITIALS