HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED: �'c� — C) / /
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: aIa%
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
J�\E cG ST. LUCIE COUNTY P BU LIC WORKS
�y BUILDING & ZONING DEPARTMENT
h ' 2300 VIRGINIA AVENUE
'0<OR\OP FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:
2. S/D NAME: 'SITE PLAN NAME:
3. PROPERTY TAX ID#: 3q/5--SOi ^ 000AS— 000q V60003)
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS C`rN
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
wa—kQ S (c,� 94. kris x I l Q � elec�c,
11. SETBACKS (ACTUAL) FRONT: BACK:- RIGHT LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION (] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[� OTHER (SPECIFY) S 1 1
13. DESCRIPTION OF PROPOSED USE: Cacp � %\h�
14. )q. Ft./CONSTRUCTION: , 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: $ 60
The value of construction is used to determine the amount of permit fees to be assessed. 5t. Lucie County reserves the right to question and/or modify ,�,p{€x
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 $2506
or more, a RECORDED Notice of Commencement must be submitted with this application. n b, 6 ) i
SLCCDV Form No.: 001-02
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION: C r
NAME:ei
Q
ADDRESS: b
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Toy-= �l�C.�'e-- ZIP
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CITY: V 1 0 STATE:
PHONE (DAYTIME): (SI,, 11 `-4 to,4 - "f 2L
In
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME
AND ADDRESS
BELOW.
' FEE SIMPLE TITLEHOLDER: �Qs � �l.��
G
y C/�
ADDRESS:Q...
'. CITY:
'STATE, Ca.. ZIP
'.. 1.
PHONE (DAYTIME):!DDID
CONTRACTOR INFORMATION
ST. of FL REG.ICERT #: ST. LUCIE COUNTY CERT #i
_
- BUSINESS NAME: Glc4n cnn��0-�;
QUALIFIERS NAME
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"aD' ST-,' 1 ` bob
ADDRESS:
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CITY: STATE: ZIP
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PHONE (DAYTIME): &k\) 3 3 5 ` FAX NO.
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ARCHIT/ENGINEER:
'
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ADDRESS: ..
CITY: l A In N�STATE: ZIP
r r,`
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP
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.
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.
OWNER/CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLORIDA _
COUNTY OF 122 ,)C4
The foregoing instrument was acknowledged
before e�this%2 day of��, 20�, by l�
L,.1 L &V4C4 .. ho is personally know o m or who
has Droduced n as identification.
' Signaturer of Notary
Type or Print Name of Notary
Notary Public Title
STATE OF FLORIDA
COUNTY OF 5�
('
The foregoing instrument was acknowledged
before me jhi--day ofll�- it 1 , 20_L�, by A�!)
who is personally known to me
or who as produced n as identification.
$ignature of Notary
Typ�rl Notary
Notary Public Title
Commission Number Commission Number
(seal) w Robert W. Rohs Rohs
w' Seal"'#'r'l`' +15734 EXPIRES
MYCOMMISSION# CC915734 EXPIRES (seal) '2' My Cr
April 21, 2004 ;m. "004
`- BONDED iHRU TROY FANINSURANCE, INC. .. ... r dIHSU"ANCE, INC
NOTE: TWO (2) ;IGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
BP #: old/D �&(
SECTION:
' (1
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
/ ' /^
" v
LAND USE:
LOT CVG W
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
LV:
MAX HGT:
CST TYPE:
OC PE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
�j`�
PUBLIC BLDG
HABITABALE
RADON FEE
CODE
` y U U
IMPACT FEE
AREA
I
(RADON)
Y
N
ROAD
GROSS ROAD
D/.
CR
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
T
IMPACT FEE
DUE
Y
N
SCHOOL
CREDI
-
TOTAL
IMPACT FEE
'-
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ELEC7�CZCRL
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE
REVIEWED BY EXAMINING TURTLE
DATE
COMPLETE
INITIALS R✓W.