HomeMy WebLinkAboutApplication for Zoning Compliance1 v `tie,
OFFICE tISF ONI V-
DATE FILED: .�)/J IU'I
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:—
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MAST BE COMPLETE a FILLED IN TO BE ACCEPTED
ST. LUCIE COUNTY PUBLIC WORKS a / BUD
BUILDING & ZONING DEPARTMENT /
2300 VIRGINIA AVENUE Ca /Valwut
FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJEC INFORMATION l�L 3�Gi
1. LOCATION/SITE ADDRESS:
2. S/D NAME: SITE PLAN NAME: `^� �rt� 5 E
�i��-�.ravE
Ctivv. r.�-ZF..r lJl.. N-rE.SL
PROPERTY TAX ID#: 3�Z13t �toOZc��po3 �o< 332 7 ado Z c�ca3�coC��
LEGAL DESCRIPTION (attach extra sheets if necessary): c T �� Zi tawvSt 1 P toS ti u-'39 enS
// (t/5. BOOK 4A PLAT 6. NO E I\_ NA 7. NLO. ��� 8.ON;%
9. PARCEL SIZE: ACRES/SO FT. �� LOT DIMENSIONS C,� Sot i IJE S� 2vt CE S �csr eN
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
w/ AtCT,oirrer —
11. SETBACKS (ACTUAL) FRONT: RIGHT LEFT
Zvi \ O I SIDE "Z-O SIDE: l C-
12. TYPE OF CONSTRUCTION (Check all appr
[� NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL jam] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: CA-22W 145.11 PC Z i1 W QP CR-2A t CL- S7'AA-" Q k
14• Sq. Ft./CONSTRUCTION: 42 04(-rb; 133CL��15. Sq. Ft. 1st Floor: -
16• VALUE OF CONSTRUCTION: $��
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 mod'�� 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 $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
ti'7� h
5p
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SLCCDV Folin No.: 001-02
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME:
ADDRESS:
CITY: - S UQq+ STATE: 1- �-� ZIP _
PHONE (DAYTIME): (�W 1 l Z-"C!:)533
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG.10ERT #: C-�a>Lo Sg<
STATE:
ST. LUCIE COUNTY CERT #:
BUSINESS NAME: \z "'`yt- wt- ��.wOL�lACY1 .L1JG
QUALIFIERS NAME:F, cN�ASY-CL%-UL- �G2Ji�tJS
ADDRESS:
CITY: `�61"��$SZ.O��C L t n S STATE: .A ZIPO'Ly
PHONE (DAYTIME): C' 1zks�k1 L—ks L-1 gy FAXNO.
ZIP
ARCHITIENGINEER:
ADDRESS:
Ci'. S�C1Z p�N ScC E�\gV
3 oz�t
CITY: �GM (3;t.a��,G-PANES :STATE: �� ZIP �.
PHONE (DAYTIME):
BONDING COMPANY: NAP
ADDRESS:
CITY:
MORTGAGE LEI!DER:
ADDRi SS:
CITY:
STATE:
STATE:
ZIP
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.
ri
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
COUNTY OF',!�t
The foregoing instrument was acknowledged
efo a me this Z day of � 2W�, bya�} 4i�n
, who is personally known to me or who
has
—produced
—� "7 • i— • as identification.
A
Signature of Notary 1
-�Ib - lAn' . A "�
Type or Print Name of Notary
STATE OF FLOID-A' /
COUNTY OF � ✓U
The foregoing instrument was acknowledged
before me this 3� day of ( r ( 20 / , by
c _`yhb is personally kno to me
r ho has oroduced as identification.
St nature of Notafy
Type of Print Name of Notary
Notary Public Title -
MUt EDWSA�pRtD1 HERRON, JR.
►VtJ
CDmmISSIOf, mb,�e0C4�
m� frli:l@%JARlIU]®�00
zr, 60NDW n00"
!seal) �, ��'9s ivarRw NOW
(
5 se
�9
NOTE: TWO (2) SIGNATURES AR EQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY hPFEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OFFICE
USE ONLY
SECTION:
/)
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
LAND USE:
/��...
lj(J
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLRILV:
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
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE ./
REPORT
PUBLIC BLDG
HABITABALE
RADON FEE
CODE
®
IMPACT FEE
AREA
u
(RADON)
►P'
Y N
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
Y
N
SCHOOL
CREDIT
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
�`
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY
�} .� Qj (t�Y.
TOTAL ALL
PERMITS
REQ'D
+17. •!:
.
FEES
REVIEWS
ZONING
ZQN)NG
pLANg
AANGROVE
REVIEWED BY
EXAMINI NG
VEGETATION
SEA
MAI
TURTLE
DATE
COMPLETE
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INITIALS
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