HomeMy WebLinkAboutApplication for Zoning Compliance-" ,.
OFFICE USE ONLY
DATE FILED: I_%3 4S
PLAN REVIEW FEE: RECEIPT NO.: / PERMIT NUMBER 4is lJ
CONCURRENCY FEE: RECEIPT NO.: CERT.-CAP. NO.:
1.
2.
3.
4.
5.
9.
10.
IL
12.
13.
ALL INFO MUST BE COMPLETE, & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS:
PROJECT
PROPERTY TAX m #: � � 3 ya ,S - %d q ^ py> S- - L)Ov - -3
LEGAL DESCRIPTION (attach extra sheets if necessary): .&IeqA�,z04 e1a4F' gLf r rotAA PAt'EG D a
PLAT BOOK 4293 6. PAGE NO. ��l 7. BLOCK NO. 8. LOT NO.
PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY
SETBACKS(ACTUAL)
Dtxurn: —� rcivn i alur-
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $ v ? A (� �3� 07
The value of construction is used to determine the amount ofpermit fees to be assessed. St. Lucie County reserves to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures arc 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.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION/f
NAME:! �� 4Jili✓a°? L f ��: U�"! , -�-�G
ADDRESS:
CITY: U.,r , 5 L� c> L� STATE: ��/. ZIP: 3.elg
PHONE (DAYTIME): ('7�i �i - l i�! Email: ':n'r9ow�V'/, 2by-212,V)C���J?(
1
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
ST. of FL REG.CERT #:r~(�7 /���, �`� ST. LUCIE COUNTY CERT
BUSINESS NAME: r��?�tl��L° /r1L ��'�a�dn:'1 ✓�vl'f i.�/ s Jam• �' -�/c
QUALIFIERSNAME://�/ JsjTJ��SL� ,
ADDRESS: '/ ) �� 6 i -si
CITY: J,A�4yt7� STATE: �,� ZIP:
PHONE (DAYTIME): (77.X7� FAX N0. Y.3 Email: /xT ' C
pp
ARCHII'/ENGINEER: j?� �,LYS' l.�r f?Crl,
ADDRESS: �r�_q ✓ tS� Cn/�I/4N �3� _S.a�F ,��
CITY: J jet STATE: /Z-/ ZIP: 3419 7
PHONE (DAYTIME):
BONDING COMPANY: n,
ADDRESS:
CITY: STATE: ZIP:
l
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: 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
r
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 IMPROVEMENTS 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.
OR
ST TE OF F]
LINTY OF
The foregoing instrument was acknowledged before
me this 16 day of 20
by 1
wh is personally known or has produced
identification.
CO RACTOR SIGNATUY
STATE OF FLORI r ���
COUNTY OF 6� .f
The foregoing instrument was acknowledged before
methis/,EdJayof 201K.
who is personally known or has produced
as identification.
Signature of Notary ,��µ9N ELLEN L. ROULETTE ature of Notary
tP oe., ELLEN L. BOULETTE
=2°. ,`�:�: Notary Public -State of Florida �PRv vGe��
p �_� `�':; Notar Public State of Flori
Commission No�� �d « 21)My Comm. Expires Sep 25, 20 mission No, f . c I (O@Arn. Expires Sep 25, 20 5
oo-aec Commission # EE 101180 Commission # EE 101180
1�iii ����'� OF
Bonded Throuy i National Notary Assn. �,,.`�� Bonded Throuy;1 National Notary As n.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUILDER, 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 OWNERIBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #:
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
PLC
LAND USE
LOT CVG %
TAZ NO.
V�
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 111990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
1
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
_
G�
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC —� GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING f/
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUN ER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
4 4
DATE
COMPLETED
INITIALS