HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED: /r 00
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPART
MENT
® 2300 VIRGINIA AVENUE
'O<ORI00' FORT PIERCE, FL 34982-5652
561.462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: t ` L '
2. S/D NAME: SITE PLAN NAME:
3. PROPERTYTAXID#: 341:6- 03('00/9 - 0'fo/s
4. LEGAL DESCRIPTION (attach extra sheets if necessary): /�' 365. L
5. PLAT
BOOK
6. PAGE
NO.
7. BLOCK
NO.
`ssr��u�
,; / Iv
i j' .ice h .:'.-
8. LOT
NO.
9. PARCEL SIZE: ACRES/SO FT. LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 10 :rU fWJ (S44 A (A$T
OA):e- S In l W .LUM ( 4h TMeD Slr.nl
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ j RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[�] OTHER (SPECIFY)`''/
13. DESCRIPTION OF PROPOSED USE: S.IA)6L �---b <1 /ApVe,az%/V
14. Sq. Ft./CONSTRUCTION: ('04_ 15. Sq. Ft 1st Floor.
16. VALUE OF CONSTRUCTION: $
The value of consruoion 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 $250o
or more, a RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION-
NAME:
/�_ 1 NAME: f� / - N < i"�.L S LG,JJ k-ryj �`
Y /
ADDRESS: �\ �yy'�iVJ //V� UE�'Z °`il v 2+�•
CITY: Q,A '��j�1 C.N.GI L�" STATE: ZIP �� 1
PHONE (DAYTIME): 611 814s ^ 0 `a
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:
STATE: ZIP
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REGJCERT #: GT 0 oc j_ ST. LUCIE COUNTY CERT - �• ,/
#:
BUSINESS NAME: Aj
QUALIFIERS NAME:
ADDRESS:
r.
CITY:�y� - I gyp. STATE: ZIP 3..
PHONE (DAYTIME): 4>`tJ�1 YID0 O FAX NO
ARCHIT/ENGINEER:
ADDRESS:
CITY:
STATE:
ZIP
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 SI BJ CT TO ATTA HMEN?; AG A. CONDITION OF THIS PERMIT YOU
PROMISE IN GOOD FAITH TO DELIVER A COP"= r`F f wE ATTACHED CONSTRUCTION LIEN
LAW NOTICE TO THE PERSON WHOSE PROF- 1s7 V, i5 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 aoDlicahle laws ranwl.ti .,
STATE OFF `/ STATE OF FLORIDA
COUNTY OF_aL 1 - .Iei P COUNTY OF—' ' U6,0,
The foregoing instrument was acknowledged The foregoing instrument was acknowledged
before me this day of ✓em,0_, by i cr f before me this day of 20_ by
who is personally known to me or who n,rrr>rr K�lt� who is personally known to me
has produced J as identification. or who has produced as identification.
Wit' G_aJ e, - . &Axsh)
S nature of No ry Signature of Notary
' _Y71P1�55�[.�arK�
Type or Print Name of Notary Type of Print Name of Notary
Notary Public Title Ngtary PublicTitle
Commission Number` 3'- Commission Number
(seal) 70' Ctq NC,LISSALBARKER (seal)OFF[C7ALN cY'SEAL
BLICQ't'A`fEOFFLORtpAMELiSSA ..RKER. 7C�N NO. CC M100 N01'ARY P[JBLIC OF FLORIDA
NOTE: TWO (2) �q; ➢ EACH SIGNATURE MUST B COMMfSBIC CS98100
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, NWm_NR MUST PERSONALLY API'EAF
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
BP m ar vl 1
0FFrcE
usE;a Y
SECTION:
TOWNSHIP:
RANGE:
MAP NO.:
3 / 7//5
ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:>. -
SPRINKLERS
STORMWATE
R
LOT OF REC (be1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REO'D
APPRV'D
DECAL
LIBRARY
PARKS
.. PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLDG
HABITABALE
RADON FEE
CODE
IMPACT FEE
AREA
(RADON)
Y N
ROAD
GROSS ROAD
CfiiiDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
Y
N
kk.
r
SCHOOL
CREDIT
::i
,
TOTAL
IMPACT FEE;.
.:
SCHOOL
IMPACT FEE
POLICE FEE
IRE FEE
MISC FEES:
TOTAL'S
-
POLICE/FIRE/
11
MISC. FEES
ADDITIONAL-
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE
)��
t 1`o C
INITIALS