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HomeMy WebLinkAboutZoning ComplianceDATE FILED: cl- l - 1 �y I PLAN REVIEW FEE: (r"D RECEIPT NO.: Si i� PERMIT NUMBER: CrI ©"I " ( )�v CONCURRENCY FEE RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE u FILLED 1N TO BE ACCEPTED G\E c�G ST. LUCIE COUNTY PUBLIC WORKS D BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE OR1�Q' FORT PIERCE, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITYIZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: °�� 1R05 Z - L-/l ^&. CAP( 31 i9ge- 2_ S/D NAME: _ SITE PLAN NAME: / 3. PROPERTY TAX ID#: �L(�ji'�'-3�I [� ©�0 - cb©c�,, 4. LEGAL DESCRIPTION (attach extra sheets it necessaryr 3 4 3 �' N (ZS 100 p+" oF'v.1 1)9H- of-�E )5 PfC oh5E•114 OPF SW A (73, aR 1Oq-3—y39j i853 b PLAT. 6. PAGE - 7_ BLOCK 8. LOT BOOK NO. _ NO. s -= NO. _ PARCEL SIZE: ACRES/SO FT. u, qT LOT DIMENSIONS t001 11 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: n 11. SETBACKS ATUAL) FRONT: BACK: I '1 RIGHT t SIDE 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] RESIDENTIAL J OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: [) EXPANSION/ADDITION [ J COMMERCIAL `--LEFT A'a� SIDE: [ j INTERIOR RENOVATION [ J INDUSTRIAL r 14. Sq. FLICONSTRUCTION: 1 % 5 15.. Sq. Ft. 1st Floor 16. VALUE OF CONSTRUCTION: $b The value Of constrnrction is u4ed to detern ine the amount of pemwt fees to be assessed. St. Lucie County reserves the right to question and/or modify the Indicated value of construction it is demonstrated that the submitted figures am not catsistennt with similar types of construction activities. If the value Is $2500 or more, a RECORDED fbpco of Commencement must be submitted mVi this application. t 2ir-' SLCCDV Form NO.: 001-02 OWNER INFORMATION: NAME: C) 9 o� ADDRESS:(") CITY: ~� tay G7r STATE: —r1: A ZIP:�� PHONE (DAYTIME): 7A S J 7 of 5 1 2— 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): f I: CONTRACTOR INFORMATION ST. of FL REG.JCERT S: BUSINESS NAME' QUALIFIERS NAME: ADDRESS: CITY: PHONE (DAYTIME): ST. LUCIE COUNTY CERT A. -• ARCHITJENGINEER: ADDRESS: F i 7 t� r � �^ �„•'V� L I lv Ay'? CRY: '`� c•� �9 STATE: To DP , !L-J PHONE (DAYTIME): l�� �c_ V BONDING COMPANY: ADDRESS-, .. .. ._ - CITY: STATE: Zip MORTGAGE LENI)ER: ADDRESS: CITY: STATE' ZIP IIVIPOR,1'Ali1 NOTICE. When a permit.is, bstled and it is not=picked up within 60 days after notification it will be voided and returned io 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 concurency 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." OWNEPJGONTRACTORSIGNATURE CONTRACTOR SIGNATURE STATE OF FIX STATE OF FLORIDA COUNTY OF. COUNTY OF The foregoing' instrument was acknowledged The foregoing instru ent was acknowledged efore me this a day of, 20 by Lrf NpZv before me this _ y of 20_, by &6Y C , who is� e'r_so�n�lyn known to me or who has produced as identification. or who ha � Signatur of Notary f Signature Type or PriAt Name of Notary o t� i Type of R {�fa Notary Public Title m N No 1Z Commission Number < o is personally known to me produ ed as identification. f otaFy Name of Notary blic_ Title Commission Number (seal) k W (seal) 0 NOTE: TWO (2) SIGNATURES ARE REQUIRED. NATURE 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. SECTION: - A TOWNSHIP: _ � RANGE: - LAND USE: 66m G e� - FLOOD ZONE: . FIRM MAP #: - 1 5 1ST RR ELV:ly CST TYPE: - OCCP TYPE: MAX. OCCP: WATER: SEWER: SPRINKLERS. LOT OF REC ('be tr I/90) LOT OF REC (attr 1/90) - LOT SPLIT REQ'D - DECAL LIBRARY - PARKS NUMBER IMPACT FEE IMPACT FEE I REPORT 4PUBLIC - BLDG HABITABALE 1 CODE V . IMPACT FEE ., r AREA (RADON) . ROAD ..GROSS ROAD CREDIT IMPACT ZONE IMPACT FEE - :DUE. . SCHOOL - IMPACT FEE K POLICE FEE FIRE FEE - MISC FEES: ADDITIONAL SPECIFY: PERMITS Y `•"'"' - READ. BP # MAP NO.: MAX HGT: ' - # OF FLRS: - STORMWATE R LOT SPLIT APPRVD.... PERMIT FEE RADON FEE YJ N TOTAL ROAD IMPACT FEE TOTAL �.., SCHOOL .�_ IMPACT FEE M'y POLICE/FIRE/ MISC. FEES TOTAL ALL FEES REVIEWS ZONING ZONING _ I-REVIEWEDBY PLANS.. I VEGETATION SEA MANGROVE EXAMINING TURTLE DATE 15 INITIALS