HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE -.USE ONLY:
DATE FILED: O? - 5 - (5 / h
PLAN REVIEW FEE: � RECEIPT NO. D �!d PERMIT NUMBER: �Q d DD '7Q
CONCURRENCY FEE: g155- RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MOIST BE COMPLETE 8L FILLED IN TO BE ACCEPTED
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ST. LUCIE COUNTY PUBLIC WORKS (�
< BUILDING 8r ZONING DEPARTMENT
2300 VIRGINIA AVENUE
20R1�P FORT PIERCE, FL 34982-5652
561-462-1553
AP IC-ATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COM
PR TCT INFF-7AT:%L
1. LOCATION/SSIITE AtDUD__R11ESS: L� Fti r T�rrzRor ,'C �rtar _r_�r � rf
rit�rl -IT ZfnC�vsl rr4l P4r CC
l� 2. S/D NAME: 1 �� SITE PLAN NAME:
nth 011c
3. PROPERTY TAX ID #: 14Z9 - 5o l- 603Z - 000l oo33 - oeo/,
4. LEGAL DESCRIPTION ch extra sheets if
5. PLAT 6. PAGE 7. BLOCK z
BOOK NO. NO. 3
FVWEa
Q; r 'D 5 r,' 6o�e 1'5
14Zg- so 1- oo35- 000,
f ��'1 ludJST�na1
8. LOT
NO. M /3
V�� z. , ,
9. PARCEL SIZE: C ES/SO FT. 7r LOT DIMENSIONS57q,o Xi6 x 34.Z4X SZhq.o x
�_
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
l'U9 �c9r �C), �9 O *1
11. SETBACKS (ACTUAL) FRONT: ! BACK: t RIGHT LEFT _I
SIDE SIDE: _4-
r
12. TYPE OF CONSTRUCTION (Check all app p e boxes)
[ ] NEW CONSTRUCTION EXPANSION/ADDITION (] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL INDUSTRIAL
[ j OTHER (SPECIFY) /y
13. DESCRIPTION OF PROPOSED USE: QAQ Par bS ��C1F Q �pfi
14. Sq. Ft./CONSTRUCTION: 75
5F 15. Sq. Ft. 1 st Floor: Inh t?i
16. VALUE OF CONSTRUCTION: $ 1 4no ozoo
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 oonsistent with similar types of construction activities. If the value is $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
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SLCCDV Form No.: 001-02 '►IC.*
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
j/�
NAME:
ADDRESS: y {/
CITY: �'i� Q. (G�i STATE: _` ' ¢ ZIP / - 4 "
PHONE (DAYTIME): ! ah 4u, � 3036
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AN ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER:
•
ADDRESS:
CITY: STATE: ZIP #
PHONE (DAYTIME):
CONTRACTOR INFORMATION /�
St. of FL REG./CERT #: � C� 19 0, ST. LUCIE COUNTY CERT #: u s
k
BUSINESSNAME:c,�� K. �/TI�IS-1'�(�G✓ l�b
QUALIFIERS NAME: T.�ot9�1�aS �if[I6�
ADDRESS:
CITY: 4'4yilI pf-,e f�/t, p/�" STATE: 6�.iZIP °.
PHONE (DAYTIME): -_(4/)FAX NO. 5f6I-46 —76�6
Re)6 Mul(Ins-
ARCHIT/ENGINEER: �P�`(^$i( Id C,k ;0c,
ADDRESS: _ . .1I' W� -.C7� T I/n i !j- � �Vlk Q�(,
CITY: ' `7//Q' /fi1� STATE: ZIP' 34g94
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY: - STATE: ZIP
MORTGAGE LENDER:
ADDRE 3:
,7Y:
STATE: _ ZIP
M"P'ORTANT NOTICE: When a permit is issued and it is not picked up within 60 days
$fter 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
-a with all ppli le laws regulating construction and zoning.
D
OWNER/CONTRACTOR SIGNATU CONTRAC OR SIGNATURE
STATE OF FLORIDA
COUNTY 0FS7_-
LGt%!E
The foregoing in trument was acknowledged
befor me th's day ofGL'8 . , 200/ , by
�/N 65T�o is p
girsonally known to me or who
has roduced as identi nation.
ignature of Notary
Type or Print Name of Notary
Nota Public Title
CGIZ6_9_4,Comm's�apitv��°J�urrrer A. Priest
a`�1.
o" SCommisson#0C971587
(seal) a q= Expires Nov. 7,2004
'r Bonded Thrn
14, Ft S' Atlantic Boedin8 Go., 1W.
STATE OF FLORIDA
COUNTY OF D-
The foregoing in
,Vrument was acknowledged
before me this 2- day of &&V& 20 0 , by
PO� Alvi C , who is personally known to me
or ho has produced as identification.
S nature of Notary
RDGe,2 A 1,212 1IFsr
Type of Print Name of Notary
Notary Public Title
uc�7z Commission der PO er A. Wriest
S'.,Gammts'on#CC9't1587
(seal) - aw $.,plres Now. 7,2Bt14
v oe Bonded Thy �G
Bondln@
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.
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All
SECTION: 129 TOWNSHIP: RANGE:�\ �a... MAP NO.:
ZONING: LAND USE: LOT aZ, TAZ NO.:
FLOOD ZONE: x FIRM MAP #: -1L / Yn; 1 ST FLR ELV: MAX HGT:
CST TYPE: / \/ OCCP TYPE: 1(rMAX. OCCP: # OF FLRS 1
WATER: SEWER: SPRINKLERS SSTORMWATE
LOT OF EC (befr 1/90) LOT OF REC (a8r 1/90) LOT SPLIT LOT SPLIT
N'1 R I REQ'D APPRV'D
I
DECJL LIBRARY PARKS t3LPERMIT
NUMBER IMPACT FEE °��' IMPACT FEE FEE
REPORT
PUBLIC IMPACT FEEG '; �9 AREA HABITABALE RADON FEE
CODE
I (RADON) '[t•J b O /
ROAD GROSS ROAD., l I C EDIT TOTAL ROAD
IMPACT ZONE , IMPACT FQE v /- IMPACT FEE,. _ b
DUE
SCHOOL ��CREDIT TOTAL
IMPACT FEE - SCHOOL
` - IMPACT FEE
.- /O �f
FE<�STOTAL
POLICE FEE FIRE FEE MIS : l ,�
POLICE/FIRE/
MISC. FEES `-
t
ADDITIONAL SPECIFY: TOTAL ALL
PERMITS FEES
REQ'D
REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGF--'VE
REVIEWED BY EXAMINING ~/ h/ TURTLE
DATE
COMPLETE
INITIALS �> J