HomeMy WebLinkAboutZoning ComplianceDATE FILED: ��'• a 17 5%2 Dg4d 7- 01 & t5
PLAN REVIEW FEE: _�(} CO�RECEIPT NO.: F�G PERMIT NUMBER: I
CONCURRENCY FEE: J el-5 RECEIPT NO.: CERT. CAP. NO.: _
ALL INFO MUST BE COMPLETE u FILLED IN TO BE ACCE"ED
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G�6 cOGy ST. LUCIE COUNTY PUBLIC WORKS
~ BUILDING &ZONING DEPARTMENT f� �.,[ bab 15
2300 VIRGINIA AVENUE
'20R10P FORTPt72-4621553FL 82-5652 �;GG;n� r
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APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: L/?_Z:o lYC}% Cm-,OFfkh PS -&-5k19F7
2. S/D NAME: SITE PLAN/ /NAME:
3. PROPERTY TAX ID 2_33--04)W - Ole,, rr��r�
4. LEGAL DESCRIPTION (attach extra sheets if necessary): k2-1- 15 `-39 C zi �i 39 rfic��� KEC U(—
�x )eyL S �q° 55� �� aloes n( �, 5e� 7 c�.37 a t 1 �lu� Gi,�
S. PLAT 6. PAGE- 7. BLOCK 8. LOT
BOOK ./i NO. /� NO. NO.
535 0 & � - !)o 6&1. 1335 K
9. PARCEL SIZE: ACRES/SQ FT. 2A—Ats LOT DIMENSIONS �
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: 1IIP)JrlL�l �%�.L
1 0 p `t Nn r N'' '` 4k, At�!'A4 t1 Z �fne.• 6J,F�.rne. 1'
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
rJ/i1 SIDE SIDE: ' l
12. TYPE OF (Check all appropriate boxes) •.. I �"l li1
pC] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED U - �� R
14. Sq. FtJCONNS RU TION: 15. Sq. Ft. 1st Floor.
16. VALUE 1 TTRUCTION: $ 57, oam
t
The Value of construction Is used to determine the amount of pemut fees to be assessed. SL Lucia County reserves the right to , Ilan and/or modify Me
indicated value O wwh ciien:it it is demonstrated tot Me sub niRed figures are not cc6istent with simlar types of construction actMHes. Ifthe value is $2500
or more. a RECORDED Nellie, of Commencernent must be submitted with this app4caGon.
11 700 "
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ti h _ ��y�
SLCCDV FOffn No.:, 001-02 -
OWNER INFORMATION:
NAME:
ADDRESS:
CITY: _ `-"�'p1 'Ry/ STATE: ' ZIP
PHONE (DAYTIME):
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). ( 1
CONTRACTOR INFORMATION
ST. of FL REG.10ERT #: - ryry
BUSINESS NAME: - lY I.(E &
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME): l i
ST. LUCIE COUNTY CERT #:
STATE:. ZIP
\ )) FAXNO
ARCHIT/ENGINEER: pp�� ((�'�y f N A�J A-) C.,
ADDRESS: cG " % .
CITY: STATE: :.ZIP _
PHONE (DAYTIME):
BONDING COMPANY.
ADDRESS: 1A
CITY: r STATE: 71P'
MORTGAGE LENDER:
ADDRESS: „ ...- . ..
CRY: STATE P
IMPORTANT NOTICE:, When •a permit As issued and it is Inot>picked up within QQ days n
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. 1 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_ t 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.
i
PWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable taws regulating construction and zoning.
01NNERfCONT CTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLO DA
STATE OF FLORIDA
COUNTY 0 ywrI6
COUNTY OF
The foregoing- instrument w acknowledged �,, �r
The foregoing instrument w acknowledged
fore me this day of 20so, by Al�L—
before me this _ day of 20� by
''. vitro isrerson known to me or who
who is rsonally known to me
has produced identification,
or who has produced as identification.
Signature tary
Signature of No ry
Type or Print Name of Notary a
Type of 'nt Name of Notary
NotaryPublic Trues
ota Public Title
Commission Number" m
Commission Number
N A9
(seal) -.-' 63 :
(seal)
NOTE: TWO (2) SIGNATURESARE REQ H SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDIN RIB AN OWNENBUILDER, THE OWNER MUST PERSONALLY APPEAL
TO SIGN THIS APPLICATION IN FFI LISTED ON THE FRONT OF THIS APPLICATION.
t-
SECTION,
-Iti, TOWNSHIP:
RANGE: 9E MAP NO.: 1422tX
10 a
ZONING:
'- "Jr -- LAND USE:
6-5 LOT CVG %:. � .. TAZ NO.: -
FLOOD ZONE:
/ \' FIRM MAP #T:"
{{
1
' ..1ST FLR ELV: MAX HGT:
CST TYPE:
- OCCP TYPE:
MAX. OCCP: # OF FLRS: -
11
WATER: SEWER: SPRINKLERS STORMWATE
"'lll R
LOT OF REC (betr 1/90) LOT OF RE C (afL IMI LOT SPLIT LOT SPLIT
APPRVD
- DECAL
LIBRARY
PARKS
PERMIT
li
NUMBER
IMPACT FEE
IMPACT FEE
FEE
j REPORT
PUBLIC BLDG
E
RADON FEE
Q ✓✓
a CODE
O I
- IMPACT FEE
AREA
(RADON)
►7`
ROAD
1 •�M�
GROSS ROAD
,'CREDIT
TOTAL ROAD
j
IMPACT ZONE
IMPACT FEE
DUEER-
IMPACT FEE
Y
N
SCHOOL"
/
CREDIT.
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IMPACTFEE
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-
SCH OOL
SCHOOL
I�
IMPACT FEE
POLICE FEE
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FIRE FEE
MSG FEES
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TOTAL
POLICEIFIRE1
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-
MISC. FEES
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ADDITIONAL
SPECIFY:
- M/G �4 L
- TOTAL ALL
PERMITS
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INITIALS