HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY'
DATE FILED: �L
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
�J��e �O�y ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMEt�i���. Z®Y
2300 VIRGINIA AVENUE 17
20R10Q FORT PIERCE, FL 34962-5652
561462-1553
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2.
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS: -32 dd IV X1iVGt 111&11ty4y- �T lq—� �^(
S/D NAME: NIIA SITE PLAN NAME: PlPPIA/T�AGT02
3. PROPERTYTAXID#: 1325-
4. LEGAL DESCRIPTION (attach extra sheets if necessary): JEE i>'7
5. PLAT 6. PAGE 7. BLOCK
BOOK NO. NO.
9. PARCEL SIZE: ACRES/SQ FT 3' 2246PF—S . LOT DIMENSIONS 22 ' � x 6Z�•
/moo, Z63 sF
10. DESCRIPTION OF CONSTRUCTION PROJECT PR WORK A TIVITY: Cews' Ree L! t 1
61&oa.]/o f �1
11. SETBACKS (ACTUAL) FRONT: BACK: , \ f RIGHT K LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION (S/&N/S) [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: SI&A,14la,!�
14. Sq Ft./CONSTRUCTION:
`f Sq. Ft 1st Floor.
16. VELUE OF CONSTRUCTION: $ '//
The value of tonstruotion is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the right to question and/or modify the
Indicated vaiuk 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 t,0� 0 0
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION: p r
NAME: P/PPIAl �50A � CIS Ga /PMEiVT �+ '"
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): ( �) ���" T�6 -='� °2
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: SA M(r f%S
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REGJCERT #: G-CCT- 461J0 617
BUSINESS NAME:
QUALIFIERS NAME
ADDRESS:
CITY:
PHONE (DAYTIME):
ARCHIVENGINEER:
WN
ZIP
STATE:
ST. LUCIE COUNTY CERT #:
STATE: ZIP 3�94Z6
FAX NO.
ADDRESS: ....
CITY:
...... _ _ . ,.. STATE. zIR
PHONE (DAYTIME): v 1
BONDING COMPANY: /V14
ADDRESS:
CITY:
MORTGAGE LENDER: / V1
I ADDRESS:
CITY:
STATE:'
STATE:
ZIP
ZIP
IMPORTANT NOTICE: When a permit is issued and it is not. picked up within 60 dry
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 aria 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 SUBJE T 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 construct on and z nan . .
OWNER/CONT CTOF7A R SIGNATURE CO RA TO SIGN E
STATE OF FLO I A STATE OF FLORIDA
COUNTY On` COUNTY OF
The foregoing ins rument w s acknowI d ed The foregoing instrument was acknowl dged
bef re me Is L day of 20L�, b bA�me day of, 20 by
ho ' pers all known to me or ho� wdd is f 00rso —zidnown to me
has pr duced ' ��as idE:ntification. o,cad 1 a�{
slgnapure of No4y r�ur of Notary
Type r Print Na a of Notary Type o r
Print Name bf Notary
Notary Public Title Notary Public Title
CC7�Commission Number
,0' % Tracy Ann Hysell
(Seal) *40*My Commission CC748663
,,„�,e Expires June 7, 2002
i(LIW—�73-5 7o 'd
T-24 40 Commission Number
�% Tracy Ann Hyseil
(seal) **My Commission CC748663
Expires June 7, 2002
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 APFEAF
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OFFICE
USE
ONLYri
SECTION:
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
LAND USE:
Q00LOrLOT CVG W
TAZ NO.:
t
r. ,
FLOOD ZONE:
�.-
FIRM MAP #:'�-"1;--_
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:.,��'.
_.
SEWER:
_1t.T,
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1190)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REQ'q
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
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PUBLIC BLDG
-.`.
HABITABALE
RADON FEE
Is
CODE
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:.,.:._
IMPACT FEE
AREA
"'*--
(RADON)
ROAD
GROSS ROAD
zl�y
CREDIT
Y N
TOTAL ROAD
-
IMPACTZONE
IMPACT FEE
IMPACT FEE
DUE
SCHOOL
CREDIT
Y
N
z
TOTAL
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IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
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,,, \A.'
FIRE FEE
��i,-_
MISC FEES:
TOTAL
��aa
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
LREVIE'IJS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
—EXAMINING
TURTLEDATE
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COMPLE fE
INITIALS