HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY. -
DATE FILED: 1 7 /0/
/
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: ,P� l C) j a 7J
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
�° 1e gay ST. LUCIE COUNTY PUBLIC WORKS
h BUILDING 8ZONING DEPARTMENT 4y
2300 VIRGINIA AVENUE
ZOfiWp FORT PIERCE, FL 34982-5652
561.462-1553 .
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: i o2SS j+ LA) C-i r" `_C^
2. S/D NAME: t'Gt _ SITE PLAN NAME:
3. PROPERTYTAXID#: I � 7� ���1'�) on()_
V [3aq�l
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
S ✓f mac. 3gr�I( &au `f
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS /
i I Ct"
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: N7Dt , ) (Doc(eh'L-a it wr �h)lu
(may-1 :��7ilG L x > C ourirlc � �� LOUyqy_%' <C4c a1S-}Y(UGf
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT �f, S /I LEFT { )I ly cJa
/11114- SIDE N,4--SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [Y] EXPANSION/ADDLTIOit [ ] INTERIOR RENOVATION
RESIDENTIAL COMME17CIAL,''>4f J "�� [ ] INDUSTRIAL
[t,r OTHER (SPECIFY) 'mac T i"I' kit 14 t` G't -n '7hX do do I -ro Adi f[ d QGK.
s �! Qda (glob i f
�H 4
13. DESCRIPTION OF PROPOSED USE: � t [� Q A [— �1-1(7
14. Sq. Ft./CONSTRUCTION: // S' 15. Sq. Ft 1 st Floor. //,45�
16. VALUE OF CONSTRUCTION: $ .�J(/ no r
The value of cghstruotion is used to determine the amount of permit fees to be assessed. St Lucie County reserves the right to question and/or modify the
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 $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
w
THE AVERAGE PROCESSING TIME FO(R� MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
STATE: ZIP
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): 1 I
CONTRACTOR INFORMATION
ST. of FL REGJCERT #:
BUSINESS NAME: -I to
QUALIFIERS NAME: 1
ADDRESS:
CITY:
PHONE (DAYTIME):
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
NU
STATE:
ST. LUCIE COUNTY CERT #:
-t( .( 0-y", STATE: - ZIP ,
f FAX NO.
28Fs-7oS2
��n af l' 0-0
11 � 3 fay -a- 4—h eC�t
uG-,/ STATE: ZIP L�
STATE:
STATE:
LP
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. 1 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.
�6WNER/CONTRACTOR SIGNATURE C N RAC OR SI NATURE
l
STATE OF FLORID STATE OF FLORIDA )
COUNTY OF �v�ii- COUNTYOF
The foregoing f' truiment as acknowledgedThe foregoing instrument was acknowledged
before, me this day of 200c; by Ch�� before me thisf.L day off'_ C . ,tip by
�.
lOwho is ersona' 1 kn5wh-1:o me or who U L-t-Cut dccc who i ersonall _kno_wn to me
y_
has produced --as identification. or who has produced as identification.
tureofN Lary nature �f otary
Ci,
� . ��'
-t —__T pe or Pri . ame of Notary Type of Pn t Name of Notary
Notary Public Title Notary Public Title
AwCo remission Number Q
CC�t� Commission Number
(seal) SALLY A, FORD (se;
+ F N 9 200,s 65
,� 09 2004
NOTE: TWO( IRE EACH SIGNATURE
IF APF'-YING FOR IT AS AN OWNER/B
TO SIG V THIS APPLICATION IN THE OFFICE LISTED ON Th
SALLY A. FORD
CCWAYSS*N 9 CC925965
NO SZM92ooa
A E O9kTj=TF
Y APPEAF
BP#: 1)C?7v
OFFICE USE ONLY
SECTION:
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TOWNSHIP:
1'1 C
RANGE:
f�
MAP NO.:�
Qs
ZONING:
� — L...,'
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYP-
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
'I
-
LOT OF REC (be fr 1/90)
LOT OF REC (aftr 1/90)
T —R
LOT SPLIT
LOT SPLIT
REQ'D
APPRVD
DECAL
NUMBER
LIBRARY
IMPACT FEE
PARKS
IMPACT FEE
PERMIT
FEE
REPORT
CODE
PUBLIC BLDG
IMPACT FEE
HABITABALE
AREA
RAD N=FEE
�OC
(RADON)
ROAD
IMPACT ZONE
GROSS ROAD
IMPACT FEE
DUE
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
SCHOOL
IMPACT FEE
Y
CREDIT
N
TOTAL
SCHOOL
1,
t
IMPACT FEE
POLICE FEE
FIRE FEE "
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
ADDITIONAL
PERMITS
REQ'D
SPE TOTAL ALL
FEES
F
r
r
REVIEW;
DATE /
COMPLETEy'�?f
NING
�+
999
ZONING PLANS VEGETATION SEA REVIEWED BY EXAMINING
TURTLE
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