HomeMy WebLinkAboutApplication for Zoning ComplianceDATE FILED: r -
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PLAN REVIEW FEE: n . RECEIPT NO.: PERMIT NUMBER: ��✓
CONCURRENCY FE : RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTEDno C
St..Lucie County Building and Zoning:
2300 Virginia Avenue C l Q-C- • A �"�.
.'r10R10Q Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: A-S 0 L 4 S b"-
2. S/D NAME: SITE PLAN NAME: .
3. PROPERTY TAX ID #: 7 °- (Db — 00
4. LEGAL DESCRIPTION (attach extra sheets if necessary): B15 4 CAL. (/O, 0 CXL. V �
g 15'C- —1 o iu Lc, -r �° 1; L= S ?.e� . �-1 Lf 1 F
5. PLAT 6. PAGE 7. BLOCK 8. LOT _
BOOK �— NO. _ jT NO. NO. f�
9. PARCEL SIZE: ACRES/SQ FT. Q LOT DIMENSIONS tQa
�913 X SS.S Er
F. 7 `?, by o 'U c7 N-T �2y �4,
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY. to 'i✓
� L� t r� -�L, tZ? 9 (� c� wl • �7AL cj-7--) C-D n nt--ce-r1a
]I. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT:
(� (S CD- SIDE , -5 SIDE
12.
13.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
I
NEW CONSTRUCTION
RESIDENTIAL
OTHER (SPECIFY) _
[ ] EXPANSION/ADDITION
] COMMERCIAL
DESCRIPTION OF PROPOSED USE: /F L 6 e(!) Q L l V t [J G
[ INTERIOR RENOVATION
[ ] INDUSTRIAL
k ®o k j
14. Sq. FtXONSTRUCTION- . 6 1 '�� �� 5 15. Sq. Ft. 1st Floor:
F
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 modify 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.
BSc
SLCCDV Form No.: 001-02 o.?G • y t/
.27G• °//
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OWNER INFORMATION
NAME: t& 'S L nr U Q 1r LT l-- G ( L Ul
ADDRESS: _1-(k>0.: E&A- G1r S .131z
.CITY: (A) 4Lt L- Z"uJ P STATE: I(J - ZIP
PHONE (DAYTIME): -•('l3 �j l 2 �i (o 9 . email: r2 IF THE THE FEE SIMPLE TTPL-(3iIiWN`lt) IS DIFFERENT FROM THE OWN R LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME):
CONTRACTOR INFORMATION I
ST. of FL REGJCERT #: ST. LUCIE C11
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS: s
CITY:: - STATE:
PHONE (DAYTIME):
ARCHIT/ENGINEER: '
ADDRESS:
CITY:
PHONE (DAYTIME): I
BONDING COMPANY:
ADDRESS: .
'CITY: /
MORTGAGE
ADDRESS: j
CITY: /
STATE:
STATE:
STATE:
6
JNTY RT #:
ZIP
email:
ZIP
ZIP
ZIP
Il O/RTANT 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. 1 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 applica-regulating construction and zoning.
vf�ions ,
3 —NFCON R SIGNATURE
�af���9
STATE OF FLO DA 2 N
COUNTY OF `f' y
The foregoing instrument was acknowledged a) 9
before me day of/W
f W20_q by
j
who is personally
known to me or who has produced
as identification.
LI C,
&q=FZv a 9&a�6y
Type or Print Rame of Notary
Commission No... (Seal)
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing, instrumen as•acknowledged
before me this _ d of ; , 20___, by
who is personally
known to me o ho has produced
as identification.
of Notary
Type or Print Name of Notary
Commission'No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN -THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.