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HomeMy WebLinkAboutApplication for Building Permit Certificate of Zoning ComplianceOFFICE USE ONLY: DATE FILED: PLAN REVIEW FEE: RECEIPT NO.: /� /^ C/V �lit y Q PERMIT NUMBER:?p/l� ALL INFO MUST BE COMPLETE 8T FILLED IN TO BE ACCEPTED ST. LUCIE OUNTY PUBLIC WORKS QN� BUILDING&ZONING DEPARTMENT i '",,,,{- 2300 VIRGINIA AVENUE t'1 e� (,L(f-(la U" . FORT PI561-462- 553982-5652 �o fie_ APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCEj¢ PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: ktyw Ht-14 w" f��. I 'fcrec'5r OP.* 2. S/D NAME: blKts too rots SITE PLAN NAME: AjW tc fiRvy Gn, (rj. 3. PROPERTY TAX ID #: 3 1 / - CS o - 4. LEGAL DESCRIPTION (attach extra sheets ifnecessary): r% '250 _W� of _UAk ].F55W /a/,Sc--A-'f k..-70L.N'-17'rV F-pnqE39r-A St„Iuuc,C'o��fy, lA 5. PLAT 1 � 1 � 6 NO E � I r' 7. BLOCK O 6. LOT BOOK 1 � I T 9. PARCELSIZE: ACRES/SQFT. LOT DIMENSIONS r 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: / /9 4- f�i-okr 0.ge-' 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT � \1 SIDE SIDE: 12. TYPE OF CONSTRUCTION (Check all appro iate boxes) [a] NEW CONSTRUCTION [ ] RESIDENTIAL [ ] OTHER (SPECIFY) - '� [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION G COMMERCIAL [ ] INDUSTRIAL 13. DESCRIPTION OF PROPOSED USE: r'- hre tf:L Btd - ov Mn-r 41 0 14. Sq. FUCONSTRUCTION: Y 2 1 . Sq. Ft. 1st Floor: 5 orrrcF — 16. VALUE OF CONSTRUCTION: $Wtt4L (d l�jl7a,4yQ85 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 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: p y •(i".l...f% W T, C �RuSS.. �v'✓M A-Yi NAME: J pIV-W, G�: sS p�,q. it ADDRESS: [YJo ..S"� /Y 1' CITY: r-'1", .STATE r :... ZIP 3 3 3 © 9 PHONE (DAYTIME): ,y ae'f"' PfKSost. ✓lam lU�E4 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: i STATE: ZIP PHONE (DAYTIME): CONTRACTOR INFORMATION �"-��) ST. of FL REG.ICERT #: ST. LUCIE COUNTY CERT #: BUSINESSNAME: Oil JAL. 5hs-&-i✓ QUALIFIERS NAME: ORvAL ShtFL4-&l.r ADDRESS: 9-136 At. U. 5,. CITY: Pi t reez STATE: F.��' . ZIP 3Y 9 14 1- PHONE (DAYTIME): *I�Cf; I % Z )'(LS-A S1b6- FAX NO.772 `CGS' 14q `8".. ARCHIT/ENGINEER: :.�1 „� - �R.t%c.k LI I. ADDRESS: CITY: , PA t hA � f+� 4*o i41-Ns STATE: �' ZIP 3 3. y l p PHONE (DAYTIME): i BONDING COMPANY: ADDRESS: CITY: CI srare: — -- ---_ ZIP MORTGAGE LENDER ADDRESS: CITY: ... - STATE:_ ZIP IMPORTANT NOTICE: When a permit is issued and it is not picked up within ti after notification it will be voids and returned to 0v's �da 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 FLORIDA STATE OF FLO �144A COUNTY OF COUNTY OF "t The foregoing instrument as acknowledged before me this day of, ., 20A:,�Ipy CVa ili�L, who is ersonally known to me or who has produceds identification. 2-G - Signature of ry cR SE q-0mi�� Type or int Name of Notary / The foregoing nstrument was acknowledged before me this day of&_C9- , 201�L,) , by Do 0!YNho is personal) known to me o has pr duced&identification. &ZS- Signature o otary' Type of Pr"me of Notary Notary Public Title Notary Public Title Co Co ssion Number UDREyS SSION oHREY. (seal) '�_ MY COMMISSION,DD190, 7 �(seal) AUDREI'B.FIUMP{{ REY EXPIRES: Mann 6 2007 '` MY COMMISSIppI k DD 79 ' eaweamr�Nor�°" c eonaeeXP19ES:Marchfi2000387 ,< R'Pubim neni ryas `¢ P^„to` I,. 7Fm Notary PUbhq Unaerivntes NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZE . 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. OFFICE USE ONLY SECTION: ti TOWNSHIP: 2 RANGE: Jq MAP NO.: / 2/ c ,, ZONING: / LAND USE: �` LOT CVG %: TAZ NO.: FLOOD ZONE: FIRM MAP #: 1ST FLR ELV: MAX HGT: CST TYPE: OCCP TYPE: MAX. OCCP: # OF FLRS: WATER: SEWER: SPRINKLERS STORMWATE R LOT OF REC (befr 1/90) LOT OF REC (aftr 1/90) LOT SPLIT LOT SPLIT REO'D APPRV'D NA DECAL LIBRARY rr I�j PARKS y :.:1. PERMIT NUMBER IMPACT FEE IMPACT FEE Y` FEE REPORT PUBLIC BLDG HABITABALE RADON FEE CODE IMPACT FEE AREA (RADON) I ROAD 'y,,V/1' GROSS ROAD CREDIT TOTAL ROAD IMPACT ZONE f WWW��• / IMPACT FEE IMPACT FEE I' DUE Y N SCHOOL CREDIT TOTAL IMPACT FEE' i\\ SCHOOL V IA IMPACT FEE / /Y POLICE FEE ' FIRE FEE L MISC FEES: TOTAL POLICE/FIRE/ ' MISC. FEES Y N ADDITIONAL SPECIFY: TOTAL ALL PERMITS FEES REO'D REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE REVIEWED BY EXAMINING TURTLE DATE COMPLETE INITIALS f( n