HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED: rcaL 'o '
PLAN REVIEW FEE: RECEIPT NO.:
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PERMIT NUMBER: 6�/o /03&S
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1653
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 #: -243"t (2001 P D 30 � �J
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT 6. PAGE
BOOK NO.
9. PARCEL SIZE: ACRES/SQ FT.
7. BLOCK
NO.
8. LOT
NO. rf
LOT DIMENSIONS 1-CA
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
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11. SETBACKS (ACTUAL) FRONT: �BACK: ,�( RIGHT LEFT
(
1 f R ] `P SIDE iNIA_ SIDE: _
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ j COMMERCIAL [ ] INDUSTRIAL
f OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: $ d
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
indicat®d value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If th"alue i J?500
or more, a RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
2�
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
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NAME:
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ADDRESS:
CITY: Fr .. \�CI' STATE: ZIP
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PHONE (DAYTIME): (p h f"16�-i
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IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW. �,p �y // \
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FEE SIMPLE TITLEHOLDER: 1
ADDRESS:
O SOV S
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CITY: � • reve- STATE: Y'l ZIP
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PHONE (DAYTIME): (Sb1)Lt )v •' -1 A
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: ST. LUCIE OUNTY CERT #:
L-IJ 'O
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BUSINESS NAME:
Loode 6o(c,L
QUALIFIERS NAME:
\Io (� S V )' IG'' \�
Ge ��P� -S�) P- ,•..
ADDRESS:
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CITY: o+- �-Ar STATE: F2'l_.. 21P
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PHONE (DAYTIME):7y. 33� C...CQ �-1 t. FAX NO. S1'jl ^ S3S—op1
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ARCHIT/ENGINEER:
ADDRESS:
•�11��-5��
CITY: J \a-.37a _ ` STATE: `"L ZIP:
PHONE (DAYTIME): ('%j-71kA3-\�A00
BONDING COMPANY:
1 1
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER: rsR...
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 , )
The foregoing instrument w s acknowledged
before me this _2,1-day of, 20_!�J, by !-
/Va who is personally known to me or who
has prod ce s identification.
ignature Notary
1
Type or Pric,nt Name of Notary
STATE OF FLORIDA
COUNTY OF.��
The foregoing instrument wa acknowledged
[ao�before met is ay of(/ �, 200 / , by�
who isperson iij,known to me,
or who has produce as identification.
Signal of Notary
Type of Pri t Name of Notary
Notary Public Title M'= Robert W.Rons
�`.`•' MYCOMMISSION# CC915734 EX9RPq NOtary Public Title
April 21, 2004
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Commission Number '? ; ,ia ` o DEDTHRU,ROY FAIN INSURANCE, INCCommission Nu Robert W. Rohs
»- MY COMMISSION# CC915734 EXPIRES
M•.. April 21, 2004
(seal) (seal) `-'%'or iL�.'•• BONDED THRU TROY FAIN INSURANCk INC
NOTE: TWO (2) SIGNATURES 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 #: oil TI �O(as
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SECTION:
TOWNSHIP:
RANGE:
MAP NO.:
/
ZONING:
/ G
�./
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:—VAX
HGT:
CST TYPE:
OCCP
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1190)
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
PUBLIC BLDG
RADON FEE
CODE
�:
IMPACT FEE
5)7'2
4HABITABALE
(RADON)
Y. N...
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
-
Y
N
}'
SCHOOL
EDIT
TOTAL
IMPACT FEE:-
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:.
TOTAL
POLICE/FIRE/
MISC. FEES
F_ l ercic.aG
Y
N
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
REVIEVVS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLE"FE
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INITIALS