HomeMy WebLinkAboutZoning ComplianceDATE FILED: f p�'V05-
PLAN REVIEW FEE: r7D RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE:_ -OV RECEIPT NO.: CEWL CAP. NO.:
ALL INFO MUST BE COMPLETE u FILLED IN TO BE
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Gym ST. LUCIE COUNTY PUBLIC WORKS `>
® < BUILDING R ZONING DEPARTMENT
2300 VIRGINIA AVENUE
�ORt�P FORT PIERCE, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
11e(o�i t�e�mc,n� C.G.-tom I 2�
1. LOCATIONISITE ADDRESS:
2. S/D NAME: _ /�//% SITE PLAN NAME:
i L
3. PROPERTY TAX ID #: 32-2o- y3/ - 000 / - On6 - �n
S � //�� ff�: r(
4. LEGAL DESCRIPTION (attach exlra sheets if necessary): Secf;. 20 r� 31dS�nT E j T/+e
/Y o� aa 2� Qa) $/f
4e
4.c� <c Leu G. 2.r�c',A�/{- o.w. . ✓arrQ�
Gerr�a. C4nq/ fasd And c'ai/fon d- �• •� r26'r'S3,
r ov !/.e s, b33.z$"F ,d E•
5. PLAT, 6. PAGE 7. BLOCK 8. LOT
BOOK 7 S NO. y�/ NO. A44 NO. /J/A
9. PARCEL SIZE: ACRES/SQ FT. a% .o a Gres LOT DIMENSIONS l A.1/ ' x /37 9. 72
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: ker,-, eS.' c-rf,o/ Nome, Cmsf•
11
12.
SETBACKS (ACTUAL) FRONT: BACK' RIGHT LEFT
120 yys SIDE %pc, SIDE: 370
TYPE OF CONSTRUCTION (Check all appropriate boxes)
fq NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[.-]'RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
[ ] INTERIOR RENOVATION
[ J INDUSTRIAL
�t•5
. -
14. Sq. Ft./CONSTRUCTION: 7 O 15. Sq. Ft. 1st Floor: y730 f .V//
16. VALUE OF CONSTRUCTION: $ .300 Doo v®�
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:
NAME: Dim—ot.y "" 2G�0/JG{GI �2ct.�
ADDRESS: / 3 3 I a Poe, -lyre 71--a '/ 47} K u4
CITY: IC4. Pierce STATE: FG ZIP
PHONE (DAYTIME): tin 1 of /G, - :3 3 �2 7
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):
CONTRACTOR INFORMATION
ST. of FL REGICERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME): �L
STATE:
' 01S
ST. LUCIE COUNTY CERT #:
STATE:
FAX NO.
9N
ZIP
ARCHITIENGINEER: L // W^ /' / o «/
ADDRESS: � .� W>P4 her Sy !'
CITY: Y7 • �7 �Uc '¢ STATE: !' G ZIP y9 f�3
PHONE (DAYTIME): J1721
BONDING COMPANY: /!//H
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER: d//9
ADDRESS:
CITY: STATE: ZIP
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.
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.
OWN RfCONT�NATURE
STATE OF FLORIDA
COUNTY OF Li*Gf8
The foregoing instrument was acknowledged
before me this e�/ day of ef&t4_, 20 s�, by'Z—%skn
bra , who is rson to me or who`
hasproduced as identification.
4igriatureof NN
/may' p
l .ki i S / O T ra� �riUuu:rplgyl
J ���'Chns Potto �h
Type or Print Name of Notary_,4 ?%
. a per 6'?O i
Notary Public Title
Dots 52-CommissionNumf, VD154527
(seal) s ., a d
UC, STAB w,
�url,�ilni
CONTRACTOR SIGNATURE'
STATE OF FLORIDA
COUNTY OF
The foregoing instrum t was acknowledged
before me this _ d of , 20_, by
w o is personally known to me
or who has produ ed as identification.
Name of Notary
Title
/- Commission Number
(seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNEWBUILDER,HE OWNER MUST PERSONALLY APPEAR
T
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
BP
SECTION:
20
TOWNSHIP:
3t�jS `.
RANGE
MAP NO.:
ZONING
AG J
LAND USE:
AG
LOT CVG %r
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TAZ.NO.:
FLOOD ZONE:
FIRM MAP #:
2-!S ��
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
k�
MAX. OCCP:
# OF FLRS
WATER:
051
"O�JJ:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (betr 1190) LOT OF. REC (aft r 1/90) LOT SPLIT LOT SPLIT
REQ'D APPRV'D
`DECAL
LIBRARY 'A
I 2
PARKS �.
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PERMIT
NUMBER
IMPACT FEE
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IMPACT FEE
FEE
j REPORT
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RADON FEE
CODE
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IMPACT FEE
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CREDIT
TOTAL
IMPACT FEE
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IMPACTSCHOOL
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POLICE FEE
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MISC FEES:
TOTAL
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