HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE QNLY: I V DATE FILED: V p j
PLANREVIEW FEE: RECEIPT NO.: O I Ray
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER: I �6CrJ�
CERT. CAP. NO. "
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
W = PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
a ► 2300 Virginia Avenue
Ft. Pierce, FL 34982-5652 1\' r
772 2- 53 C< ��
4 CATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
I. LOCATION/SITE ADDRESS:,1P06 S!k44 12R1.& 147�lear€ R
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #: 3f/DaZ -,6619 - 0/f 7- a0e,&
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. ✓ I 8. LOT NO. /Q
9. PARCEL SIZE (ACRES/SQ FT.): l QI QM LOT DIMENSIONS: '80 X /Q?
10. COMPLETE DESCRIPTION OF CCOONSTTRUCTION PROJECT OR WORK ACTIVITY: IWAfteX
11. SETBACKS (ACTUAL) FRONT. 5,5 BACK. RIGHT SIDE: _ LEFT SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION ptj INTERIOR RENOVATION
RESIDENTIAL [' ] COMMERCIAL [ j INDUSTRIAL
[ ] OTHER(SPECIFY)ifC'.,/,(�rry80Fi��fiF�
13. DESCRIPTION OF PROPOSED USE: Re�,dArt 1
14. SQ. FT OF CONSTRUCTION: 15. SF, FT Ist FLOOR:
16. VALUE OF CONSTRUCTION: S 1,16?, Oao
The value of COMQuction 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 cousin Won if it is demonstrated that the submitted figures am not consistent with similar types of construction activities. tf the value is $2500 or more, a
RECORDED N011ce of Commencement must be submitted with this application.
SLCCDV FQrIn No.: 001-02
' `� p
UPDATED 6/25/09
ti.
OWNER INFORMATION
NAME:4 /YF/lillll.0
ADDRESS: AxechVA. ,
CITY: f tli2>'/112/Gi2Cr STATE: /&Z ZIP: � ✓�
PHONE (DAYTIl�IE): r` v) Email: 6st�£�.uJG.t�1�7F. Cory
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): (�
CONTRACTOR INFORMATION Qz�.GLr�rr
ST. of FL REG.CERT #
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME): C__)
NO.
ARCHIT/ENGINEER: GyE.CCfi IA4-,- —
ADDRESS: / w X-110. BurL%/i� Jr.
CITY: AF7"�,p/Wv7- C/g STATE:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
s. /.o
STATE:
ST. LUCIE COUNTY CERT #:
ZIP:
Email:
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.
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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR B PROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
A&
OWNEWOR CONTRACTOR SIGNATURE
STATE OF FLORID�-y
COUNTY OF �J { c
The foregoing instrument was acknowledged before
me this -7 day of L2 L-/ 20�
by C*T a Ill
achQis personally knowu _ or has produced
identification.
Commission No.
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
me this day of
by
who is personally known
of Notary
No.
Anowledged before
,20_,
or has produced
as identification.
(Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERBBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY
SECTION
dd
y:
TOWNSHIP
1
RANGE
MAPNO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
(`
FIRM MAP #
IST FLR ELV
MAX HGT
i I
l
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF RFC
LOT SPLIT
LOT SPLIT
Bclore 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
1
HABITABLE
RADON
-PERMIT
CODE
AREA '
FEE
FEE
(RADON)
LIBRARY
PUBLIC BID
P C BLD
PARKS
IMPACT
MACT FEE
r
MACT
RIPACT —
FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
RO
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
— _
IMPACT
FEE
FEE'
FEE
FIREBMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC_ ROOF -
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:' /
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
a
RECEIVED
(
O •
DATE
.1
COMPLETED
G
O
INITIALS