HomeMy WebLinkAboutApplication for Zoning Compliance• - • 111k I��
PLAN 1 'Slyy. 1' NO.:
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PERMIT NUMI33ER:
CERT. CAP. NO.:
SAC o'704? • 00-1 2-
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County Building and Zoning eA'Q-
2300PPierce,
F 34982-56 ^�
Avenue
Ft. Pierce, Fi. 34982-5652 V
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROTECT INFORMATION
LOCATION/SITE ADDRESS: J 2 I G VlA A N C ('A /Jo 54—
S/D NAME: )nfi I- (� (�� I[ STFE PLAN NAME: LJ A r
PROPERTY TAX ID #: [ 3 l [ -100 — 6 Z 6 i ^ ,o `f
LEGAL DESCRIPTION (attach extra sheets if necessary): i-� 2 540,y_
i t
PLAT 6. PAGE 7. BLOCK ' 8. LOT
BOOK NO. NO., _ NO.:
PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: t Z S+,t l
11. SETBACKS (ACTUAL) FRONT;, ,(,-) HACK:
2
RIGHT:
LEFT:
SIDE
SIDE
12.
13.
14,
TYP F CONSTRUCTION (Check all appropriate boxes)
[ EW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [ ] COMMERCIAL
[) OTHER (SPECIFY)
Tp.�wl YIJA�
DESCRIPTION OF PROPOSED USE:
Sq. Ft./CONSTRUCTION:Z' O �-
2 S-Ivf
16. VALUE OF CONSTRUCTION: $ 2 1 8 1 6 G (, I"
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
15. Sq. Ft. Ist Floor:
The value Of construction is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the rigbt to question and/or modify the indicated
value of a9listmction if it is demonstrated that the submittedfiguresare not consistent with smular types of construction activities. If the value is $2500 or more, a
RECORIE1y Notice of Commencement must be submitted with this application.
SLCCI)V Form No.: 001-02
ADDRESS: a 7" ' R P ti 1<
.CITY: Inch 6�!Zh '
PHONE (DAYTIME): Ag 7 2 S - 52
IF THE FEE SIMPLE TITLEHOLDER (PR(
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER.
ADDRESS:
CITY:
PHONE(DAYTA
_ STATE: ZIP / S Z —7 r
.%4 mail: laMAroNOA.(d^ti
PERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
CONTRACTOR INFORMATION
ST. of FL REGJCERT #:
BUSINESS NAME: IM A Boni nA - 1 i
QUALIFIERS NAME:
ADDRESS: K 6(0 L--"# S C w.4 S f,,_..
CITY ?R�+r, th,
PHONE (DAYTIME): (34
ARCHIT/ENGINEER:' t(
ADDRESS: 14 (hAr-- jo
STATE: ZIP
77
1� 5� ST. LUCIE COUNTY CERT #: 2 i 0
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STATE: ZIP 'S2 'joS
+FA)t No. 321-'7 t 5 Sia j email:
CITY: STATE:'
L ZIP
PHONE (DAYTIME): D? 3 L1 c66(f
BONDING COMPANY.
ADDRESS: - —
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
ZIP
ZIP
I
IMYORTAI 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.
CERTIFTCATION;
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, BEATERS, 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 APPLIeANTi 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.
7Z4
at all the foregoing information is accurate and that a o will be one in compliance
applicable laws regulating construction and zoning.
OWNER/CONTRACTO'k SIGNATURE CON CTOR SIGTME
STATE OF FL A STATE OF FLORI
COUNTY OF �!L COUNTY OF
ument was acknowltdRed
day of —% 2(by
Q, , , who is personally
The foregoing instrument was,acknowled ed
e ore m rili day of —7 2C6by
who is personally
to
Type or Pf Type or Print Name of Notary
LORIEAGERSTEMEIER
Commissio a += MY COMMI$�14DD 514317 Commission No. (Seal)
' 14, 2010
'•Bmdad Thiu Notary Public WMaiwmers
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 INTTHE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
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or specific instructions see appropriate permit scPOEslsFs�� xpD514317
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