HomeMy WebLinkAboutApplication for Zoning Compliancesilk .
OFFICE USE FONLY:_ Q a`ty tV
DATE FILED: / w/
PLAN REVIEW FEE: ZSd , D . RECEIPT NO.: l� g PERMIT NUMBERX�:�&D
ALL INFO MUST BE COMPLETE 8t FILLED IN TO BE ACCEPTED
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ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1. LOCATION/SITE ADDRESS:
2. S/D NAME:
[400 PROJECT INFORMA
i3` tla \7,Sr
SITE PLAN NAME:
0
3. PROPERTY TAX ID #: 1r . 1 t?IV, - a D 3f4�-sa/ -1Y66 65017.
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4. LEGAL DESCRIPTION (attach extra sheets if necessary): latc 0 a ort'
5. PLAT //// 6. PAGE / t� 7. BLOCK 8. LOT
BOOK NO. N I, NO. f_/�'� NO,
9. PARCEL SIZE: ACRES/SQ FT.
LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: O�" b ux-9
11. SETBACKS (ACTUAL) FRONT: BACK: u RIGHT
SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[&--`NEW CONSTRUCTION
[ ] RESIDENTIAL
[ J OTHER (SPECIFY)
[ ] EXPANSION/ADDITION
[ ] COMMERCIAL
9I Fe-LEFII`D["-^
[ ] INTERIOR RENOVATION
[ j INDUSTRIAL
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: 15. S . Ft. 1st Floor: l�3
16. VALUE OF CONSTRUCTION: $ '7 -- //K 3% lr O l�
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves fhe right to question ar, dlor modify the
indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar value is 52500
9 types s construction activities. ff the
or more, a RECORDED Notice of Commencement must be submitted with this application.
b
SLCCDV Form No.: 001.02
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME: oi'a /'1y � 1 � ,
ADDRESS:
CITY: STATE: `;''�-�-' ZIP
PHONE (DAYTIME): 6�7/ 1 :W - 50
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): I 1
CONTRACTOR INFORMATION
ST. of FL REG./CER7
BUSINESS NAME:
QUALIFIERS NAME:
xx
ADDRESS:
CITY:
a.�77,,..,,r
PHONE (DAYTIME):
f.Jyr l
ARCHITIENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
ST. LUCIE COUNTY CERT #: , / O ` D
STATE: gZIP {"//, 33M,
.FAX NO. 'l(O Ty � r7
/
J / 16
STATE: ZIP
STATE: ZIP
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.
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.
O NER/CONTRACTOR' IGNATURE CONTRACTOR SIGNATURE
STATE OF FL RIDS D At`�`"
COUNTY C l
The foregoing Ins ument es acknowledged
me t befor his cday ofJAAJ, 20.Cl, by _
ho is personally known to me or who
s produce as identification.
Signature Not
Diane D Joseph
Type or Print Name of Notary
Notary Public Title
Commission Number
(seal)
,k*My Commission DD380231
ow'f Expires October 17.2003
STATE OF FL RIDA
COUNTY OF
The foregoing Ins ment was acknowledged
before me this day of , 20 d/ , by
(llAi [ t�UL— who is personally known to me
o ho has prods d as identification.
�1
Signature of No ary
°Irma D Joeeph
Type of Print Name of Notary
Notary Public Title
(seal)
* *My Canmisdon CCaMi
i .,R/ Expires October 17. 2003
Commission Number
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNETBUILDER, THE OWNER MUST PERSONALLY APPEAIR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.