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HomeMy WebLinkAboutApplication for Building Permit Certificate of Zoning ComplianceOFFICE USE sONLY:DATE FILED: PLAN REVIEW FEE: RECEIP NO:: QU T Y PERMIT NUMBER: CONCURRENCY FEE: ..X- O RECEIPT NO • CERT. CAP NO ALL INFO MAST BE COMPLETE Si FILLED IN TO BE ACCEPTED CcGy� ST. LUCIE COUNTY PUBLIC WORKS a of Iry J(�?� ® ' BUILDING & ZONING DEPARTMENT e:7>1-,A U 4r�P�l °y 2300 VIRGINIA AVENUE '20R10P FORT PIERCE, FL 34982-5652 561-062-1553 KI m . 6� APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE n2�l8! PROJECT INFORMATION � )9D N, 1. LOCATION/SITE ADDRESS: _1 }i t r)vS YI L vlpr } �) eP 2. S/DNAME: Meeis T 104y)ds SITE PLAN NAME: AllardiG—rruss'Co);.+A. 3. PROPERTYTAXID#: f33!o'�I- pOb D D� 4. LEGAL DESCRIPTION (attach extra sheets if necessary): NOf kb, q5-1; 0 Ff. G� 5 p N }� "/if )e55 fcr Aoolri 4Canat to Zvi n i n 5ec 36 "rer�nsh'v +} Bch e39 E 5i; Lucie i-��I r -- Coun9-4,) FL 5. PLAT 6. PAGE 7. BLOCK 8. LOT BOOK 9/� 95. NO. NO. NO. 9. PARCEL SIZE: ACRES/SQ FT. 13.06 A{.'. LOTDIMENSIONS tf °i 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: C FRS ' 047 c e� 1+ 11. SETBACKS(ACTUAL) FRONT: BACK: RIGHT LEFT t' I SIDE 7 SIDE: I D/ 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL P4 COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: (7Tr I G Oi4�cc-5�08'}'r tick-5,08� `r 14. Sq. FUCONSTRUCTION: IN, 15. Sq. Ft. 1st Floor: Fr_ df$ ce - 3 49) r ft 16. VALUE OF CONSTRUCTION: $ _ ., 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 mo ify the indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 OWNER INFORMATION: NAME: TY) �AfI�V+'..r�s ADDRESS: 350 -E✓ei CITY: F©r+- �c;Lt�e'r t LSTATE: ZIP 30 PHONE (DAYTIME): (45fi 1-' 1-3,10 C©niotcA '�ev-Soo. Nlp `)L4 c, IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: PHONE (DAYTIME): STATE: ZIP CONTRACTOR INFORMATION h 1 1I ST. of FL REG.fCERT #: ' C> G(I 01915 5 8 / ST. LUCIE COUNTY CERT #: � Scr> T✓�,. - ' BUSINESS NAME: Dv-yai cJ'/' ed f OPT `1 ��OYi✓�1�UG1 ) �Yl �T�Ci, QUALIFIERS NAME:i ADDRESS: ;, AIR) 'Pi (l'�V L CITY: E-oqy-''1tt: Y(..exc??s,\ STATE: r1'1 r7L�7 '` t Z, tI `P 3 PHONE (DAYTIME): 1 !oIl 7� U" R$ W FAX NO. / /�S - +fP5 C" z 77A-979 -05s,9 ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: I MORTGAGE LENDER: ADDRESS: I CITY: STATE: ZIP STATE: ZIP IIMPORTANT 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. OWNER/CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE STATE OF FLQRIDA COUNTY OF - A-M Ue The foregoing . ument has \acknowledged �before ms�e this day of , 20PY byQeV)gk, who i persall nRwn to me or who has produced UQ �-� identification. Signatu of ary 044D P-sy , 44k Vk? Type or Print Name of Notary Notary Public Title Commission Number STATE OF FLORIDAC/� COUNTY OF The foregoing i strument was Acknowledged before this el day of QA, 201�py, by © N, who is p sonally known to me or who has produced - T)' as identification. Signature otNotary Type of Print ame of Notary Notary Public Title ys (seal q,n��',a., JAUDREY'B.HUMPHREY'' MYMPHREY. .;OMMISSION MDD 190387 (seal) CDMMISSION DD 1 g0387.': RPIRtS March 6,2067 �Pf„fi Bma�en iPnIRN�MarCh 6' !'l Thru Notary PmNic Wder Iwls Z�J ry PUGhc UrMerty�'ters NOTE: -G QUIRED. 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. BP #: as�oi/9 OFFICE USE ONLY SECTION: j TOWNSHIP: �J; RANGE: MAP NO.: ZONING: LAND USE: A,6 LOT CVG %: TAZ NO.: ��� FLOOD ZONE: FIRM MAP #: / Y 1ST FLR ELV: MAX HGT: CST TYPE: s f OCCP TYPE: MAX. OCCP: # OF FLRS: WATER: SEWER: a SPRINKLERS STORMWATE R LOT OF REC (befr 1/90) LOT OF REC (aftr 1190) LOT SPLIT LOT SPLIT REQ'D APPRV'D DECAL LIBRARY A PARKS PERMIT NUMBER IMPACT FEE IMPACT F FEE REPORT CODE ,., �� PUBLIC BLDG IMPACT FEE /QO� HABITABALE AREA RADON FEE K% (RADON) jV'! Y N ROAD GROSS ROAD//����� �j CREDIT TOTAL ROAD IMPACT ZONE IMPACT FEE &0% jS IMPACT FEE DUE SCHOOL CREDIT' .TOTAL IMPACT FEE >^ _ 6CHOOL,+��-' 1MPAC1`.FEE POLICE FEE FIRE FEE �J MISC FEES: TOTAL ,f POLICE/FIRE/ MISC. FEES Y N i ADDITIONAL SPECIFY: TOTAL ALL PERMITS FEES REQ'D REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE REVIEWED BY EXAMINING TURTLE DATE COMPLETE INITIALS nC