HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY: �o F, 4r
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DATE FILED: I C"
PLAN REVIEW FEE: RECEIPT NO.: U I [ 337&7 PE R: i f ( '
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: 7�
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
561
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}/�/j[� PIERCE, FL DO VIRGINIA AVENUE
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(.L) � J (J .462-1-1553
C Z& 60-133
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATICN/SITE ADDRESS: d l� D /d (% , FP �3qrc,,
2. S/DNAME:WYiite City Subdivision SITEPLANNAME: Ft. Pierce Masonic Lodge
3. PROPERTYTAXID* 3403-502-0023-000/4 ( 244f lj I
4. LEGAL DESCRIPTION attach extra sheets if see attached ` i necessary):
5. PLAT 6. PAGE 7. BLOCK 8. LOT c�
BOOK I NO. NO. NO. 'z
9. PARCEL SIZE: ACRES/SQ FT. 3 • t 1 LOT DIMENSIONS 9 x 332. %5
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
new masonic lodge /
11. SETBACKS (ACTUAL) FRONT: BACK: 3/ 3.0?0 RIGHT /7� •75 � LEFT
�38 ' � + SIDE -j�_ SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[x] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ j RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: Masonic Lodge
14. Sq. Ft./CONSTRUCTION: 4992
"���p—...���— 15• Sq. Ft 1st Floor. 4992
16. VALUE OF CONSTRUCTION: 1�_
The value of cons! j$ 3 �v
he
indicated value of wnst'uchon ife'it is demonstrated that the submitted figetermine the amount of permit ures are not consistent with similar
typees to be aUeilftd. St Lucia Countyes
reserves the ion t question an ague IS $ ,00
or more, a RECORDED Notice of Commencement must be submitted with this application. types of construction activities. If fh�
SLCCDV Form No.: 001-02
THE AVERAGE PRAW NG41AE Fdi OST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME: Fort Pierce Lodge # 87 Free and Accepted Masons of Florida
Non -Profit Corporation
ADDRESS: P n Rnv 9Q25
CITY: Ft Pierce STATE: Fl ZIP 34948
PHONE (DAYTIME): 1 )
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
B ELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): I 1
CONTRACTOR INFORMATION
ST.otFLREGJCERT#: CGC034074 ST.LUCIECOUNTY CERT#: l /&
BUSINESS NAME: G M Worley Inc.
QUALIFIERS NAME: G Mack Worley Sr.
ADDRESS: 11n N_W_ 9th S♦-.reel'.
CITY: Okeechobee STATE: F1 ZIPf 7) 2
PHONE (DAYTIME): (8631 467-2541 FAX NO. 863/467-2238
ARCHMIENGINEER: Moseley C. Collins P.F.
ADDRESS: 1.07 SW 17th Street
CITY: Okeechobee STATE: F1 ZIP 34974
PHONE (DAYTIME): (863 763-1600
BONDING COMPANY: none
ADDRESS:
CITY: STATE:, ZIP
MORTGAGE LENDER: none
ADDRESS:
Cam' STATE:
ZIP
IIVPORTANT NOTICE: When a Permit is issued and it is not. Picked uP within 611)—days
a'ter notification it will be Moided 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 concurency 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.
L
OWNERICONTRACTOR SIG URE
STATE OF FLORIDA
COUNTY OF St. Z-ua,'C�
The foregoing instrument was acknowledged
before me this �-5da of Twuw , 20_1 , by rlitck
,who is ersonal�nown to me or who
has produced 3 as identification.
Signature of tary
Type or Print Name of Notary
-A ,I "'L -
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument wa acknowledged
before me this day of L known
by
q!y li)n�� who is nally known to me
or who has pr2�'duced as identification.
of Print Name of Notary
Notary Public Title Notary Public Title
w2z 3U Commission Number Commission Number
$c t "J:- Commission
Y iart631
(seal) _ Commission#CC 476315 m Kathleen Cicio
Expires Dec. 8,2004 (seal)
PfF � AtlanttBo Bonding Thra .lac 3 ,,.- Expires MyComm�ssion8 DOA ic2
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALI Y APPEAF
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
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OFFICE USE.ONLY
,
SECTION::
TOWNSHIP:'/
RANGE:
MAP NO.:
1; f
T
ZONING:.
LAND USE:
Q ,, I�
LOT CVG W
o / /p,
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
/. 7�
1ST FLR ELV:
w-
MAX HGT:
CST TYPE:
_.
OCCP TYPE:
Z
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
O�.� J
SPRINKLERS
STORMWATE
J
R
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
_
REQ'D
APPRV'D
DECAL
NUMBER
LIBRARY
PARKS
PERMIT
IMPACT FEE
7 y
IMPACT FEE
FEE
REPORT
PUBLIC BLDG
a
HABITABALE
RADON FEE
CODE
IMPACT FEED.
AREA
(RADON)
yy� A
Y N
ROAD
IMPACT ZONE
/ / I�/�
2
GROSS ROAD
IMPACT FEE
�j l ...
CREDIT
TOTAL ROAD
IMPACT FEE
Y
N
SCHOOL
CREDIT
"-
TOTAL
IMPACT FEE
POLICE FEE
ADDITIONAL
PERC:!ITS
REQ'D
ji"
DATE
COMPLE
INITIALS
-
SCHOOL
IMPACT FEE
FIRE FEE
MISC FEES;
TOTAL
POLICE/FIRE/
MISC. FEES
�{
SPECIFY:
Chi �y:��11�Y
TOTAL ALL
FEES
ZONING I PLANS
DEWED BY EXAMINII,
VEGETATION I SEA I MANGROVE
TURTLE