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HomeMy WebLinkAboutApplication for Zoning ComplianceOFFIlCE USEONLY' DATE FILED: Loa/ PLAN REVIEW FEE: RECEIPT NO.: / PERMIT NUMBER: �A)/ �19 CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO E C y ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT �A-A 2300 VIRGINIA AVENUE • V,. OR100 FORT PIERCE, FL 34982-5652 561-462-1553 c� APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECTINFORMATION .lJ. 1. LOCATION/SITE ADDRESS: �' S�o2 a—S */ 2. S/D NAME: SITE PLAN NAME: _ 3. PROPERTYTAXID#: ��% —� d/� DO % —OeO�7 :w W 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 1VARA'V1t4>I rr *9Q C-.a.S 5/):) 6(JJ/70 %/ !06) /66 rl O ;t 15 aso F'7 D F Ae 1/7/ 5. PLAT 6. PAGE 7. BLOCK 8. LOT BOOK NO. NO. NO. 9. PARCEL SIZE: ACRES/SO FT. LOT DIMENSIONS �07©e- ldl- A 35V X D X��O 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: (?, Y d;& I Apng4i xJMc-e6 't IChSZ ;Z4G/) 71) Z�) ° 9-A% t—' x ► 57 / Al 6 61f-S'g 11. SETBACKS (ACTUAL) FRONT: r BACK: RIGHT LEFT J r SIDE c9, / q SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: t�2 t'1 14. Sq. Ft./CONSTRUCTION: �/ 15. Sq. Ft. 1st Floor. 16. VALUE OF CONSTRUCTION: $ P O The value of construction is used to determine the amount Of permit fees to be assessed. St. Lucie County reserves the right t0 question 4tal modify the indicated value of construction W it is demonstrated that the submitted figures are not Consistent with similar �yalue is $2500 or more, a RECORDED Notice Of Commencement must be submitted with this application. types Ot COnSINC110f1 aCtIVIfIeS. I/fh/IiIB, SLCCDV Form No.: 001-02 V { �/, THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS OWNER INFORMATION: NAME: ADDRESS: CITY: PHONE (DAYTIME) FT. Pi9ac STATE: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: PHONE (DAYTIME): CONTRACTOR INFORMATION STATE: ZIP ST. of FL REGJCERT #: (~!T!� o d eq I �+ ST. LUCIE COUNTY CERT #:. BUSINESS NAME: �7'Ec-� lMS`%��2,.,. S-(V'�U C'-.d QUALIFIERS NAME: tl- . migS ADDRESS: F�Y' / Ifn ..{- iU %GCS I ,49 1 AA CITY: ° STATE:- . ZIP PHONE PHONE (DAYTIME): FA° 1) '76 //- D %/ Y FAX NO. ARCHIT/ENGINEER: 6 0a A is co ADDRESS: q (o TJV D 3 :fST ,t. CITY: FT • , 016 ,4eC C STATE: Y�. `.:ZIP 34 c) a PHONE (DAYTIME): c o i 1 ,,7 ft �i` —`? %l 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 ddLs 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 applicable laws regulating construction and zoning. O ER/CONTRACTiOR SIGNATURE coNIRACTOR SIGNOURE •3 STATE OF FLO_ DA COUNTY OF�L The foregoing instrument was acknowledged before me this da u� 20:: I`j by _ wnuho is p rsonall riown to me or who ha7s produced as identification. v Signature of Notary Type or Print Name of Notary Notary Public Title ,Commission Number �',",<�� Tracie L Lamb (seal) *,ti�7rr * My Commission CC905007 ....o° Expires January 25, 2004 STATE OF FL(,?,FjIDAp COUNTY OF -`.�°1 �i t The foregoing instrument was acknowledged before me this _4L day of ` , 20�, by .who is p' a11y knobun to me ryvho has produced as identification. Signature of Notary Type of Print Name of Notary Notary Public Title C.C-StRjFjComm's;on �Iace UCTe�Fr ramb (seal) * FMYCommission CC90SM7 +,,,m•' Bpres January 25,2004 NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONA' �Y APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. BP #: Fa, �- OFFICE USE ONLY SECTION: .? 7 TOWNSHIP: a h✓ •JJ RANGE: �o MAP NO.: /(Q7,5 ZONING: LAND USE: LOT CVG %: TAZ NO.: %w FLOOD ZONE: FIRM MAP #: 1S, ELV: MAX HGT: CST TYPE: OCCP TYPE: 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 .- Y? } PUBLIC BLDG HABITABALE RADON FEE CODE U,',', a `'- IMPACT FEE AREA (RADON) Y N ROAD GROSS ROAD CREDIT TOTAL ROAD IMPACT ZONE IMPACTFEE IMPACT FEE DUE Y N SCHOOL CREDIT TOTAL IMPACT FEE SCHOOL IMPACT FEE POLICE FEE FI FEE MISC FEES: TOTAL POLICE/FIRE/ MISC. FEES Y N ADDITIONAL SPECIFY: TOTAL ALL PERMITS FEES REQ'D REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE REVIEWED BY EXAMINING TURTLE LATE COMPLETE (f I��'TIALS k (�