HomeMy WebLinkAboutApplication for Zoning ComplianceMCA F 12- C?/ 1
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DATE FILED:la
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
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ALL INFO MAST BE COMPLETE 8t FILLED IN TO BE ACCEPTS
E CpGy ST. LUCIE COUNTY WORK /
BUILDING & ZONING DEPARTMENT � WdA
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
VY & r r
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION p 5 L
LOCATION/SITE ADDRESS:
r
S/D NAME:
PROPERTY TAX ID #:
LEGAL DESCRIPTION (attach extra sheets if necessary):
'SITE PLAN NAME:
t 5: PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK 1) NO. Q �`p NO. NO.
1-
9. PARCEL SIZE: ACRES/SQ FT. '' LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: ln[r_- VlCl2\
r I r r r
11. SETBACKS (ACTUAL) FRONT: BACK:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[-I' NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [vr COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
X 18. DESCRIPTION OF PROPOSED USE: i S C(�T14N �C4a5Z <t-1
- X14. Sq. FUCONSTRUCTION: SAP -- 15. Sq. Ft. 1st Floor:
X 16. VALUE OF CONSTRUCTION: $ AA�-P2, 0 % ,- Ci • o,� nj J
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The value of construction is used to determine the amount of permit fees to be assessed. St. Lurie 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 $250(i
or more, a RECORDED Notice of Commencement must be submitted with this application.
A
i
S` 0CDV Form No.: 001.02
ThL `VERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWN -R INFORMATION: NAME: �r t2
ADDRESS:
CITY:
PHONE (DAYTIME):.. - f,"ILPI ".Loy-f".0,• ;�
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: k&N
CITY: STATE: ZIP
PHONE (DAYTIME): f I --
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: �/'.fp)C�D�
BUSINESS NAME:
QUALIFIERS NAME: q
l�
ADDRESS: r
CITY:�Efi l6,}¢ryo `i'.✓�nl bs"
PHONE (DAYTIME): jc-�) 1`4b 4
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDS: 'SS:
CITY:
ST. LUCIE COUNTY CERT #: / l
1
�
STATE: lZIP '.
FAX NO. qe;,4 }-51
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 dav5
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. 1 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 ciNT
ruction and zoning.
OWNER/CONTRACTOR SIGNATURE RA TORSI ATURE
STATE OF FL ID
COUNTY OF
The foregoing
before me this
of
o O1,by
no me or who
as identification.
or Print Name of Notary
Notary Public Title
(Se4=t: r
IMC 918969, Z 048cn01n&Ine.
STATE OF FL IDA
COUNTY OF .1%
The foregoing instrument wasl acknowledged
before me this �O JA (, by
/ onally KnQwff to me
Signnetyire of N ary
Type of Print Name of Notary
Notary Public Title
MIKEL ISAAC
(seal) MY COMMISSION# CC 918M
EXPIRES: Mar IS
b 2004
7-BOo3-NOTARY FLNomrySM1QA0ondin9,In0.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. 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.
QS�(-ZIV--1 730
OFFICE USE ONLY
SECTION:
TOWNSHIP:
RANGE:
3 .�'
MAP NO.:
ZONING:
C
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
/ V H
1ST FUR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SLA /^
6
SEWER:
5L/� /�
w 1`
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
REQ'D
LOT SPLIT
APPRV'D
DECAL
NUMBER
LIBRARY
IMPACT FEE
PARKS
IMPACT FEE
PERMIT
FEE
REPORT
CO E
r�
�
PUBLIC IMPACT FEE
I%
AREA
(RADON)
RADON FEE
$
ROAD
IMPACT ZONE
I' �h
GROSS ROAD,
IMPACT FEE
�1 -�`�I 3
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
J
DUE
SCHOOL
IMPACT FEE
CREDIT
Y
N
TOTAL
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
/ � )
(O
MISC FEES:
E/FIRE/
FEES
ADDITIONAL
PERMITS
R`Q'D
Y :
N
SPECIFY:
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ALL
JFEES
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
20VE
MANGF
REVIEWED BY
EXAMINING
TURTLEJ
DATE
COMPLETE
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INITIALS
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