HomeMy WebLinkAboutApplication for Zoning Compliance()_
OFFICE USE ONLY:
DATE FILED:
PLAN REVIEW FEE:
p (133(o'►g
� og 01
RECEIPT NO.: PERMIT NUMBER:
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
130
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: I900 V I Cq-i
2. S/D NAME:
3. PROPERTY TAX ID #: °z, `(
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT
BOOK
6. PAGE
NO.
SITE PLAN NAME
Sc e /-k76a%C
7. BLOCK 8.
NO.
Lh—c llr�i /� -01 e4'/
vw&�
1
LOT
NO.
9. PARCEL SIZE: ACRES/SQ FT. -72 LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: AV -mode- I C�/YIrnwxl / ! L'
cn e-S11/pp
11. SETBACKS (ACTUAL) FRONT:. i BACK: 1iRIGHT LEFT
'{ /YQ ( SIDE op' SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION �[�] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [) INDUSTRIAL
[ ] OTHER (SPECIFY) pp
13, DESCRIPTION OF PROPOSED USE: R esi rtvn
14. Sq. Ft/CONSTRUCTION: 3-0O 15. Sq. Ft 1st Floor.
16. VALUE bF CONSTRUCTION: $ ��d. �
The value of constrqbtion is used to determine the amount of permit fees to be assessed. St. Lucia 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
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME:
ADDRESS: P e� cy
CITY: �� ��`t°f� p STATE: E er - ZIP
PHONE (DAYTIME): ( 1
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): I 1
CONTRACTOR INFORMATION
ST. of FL REGJCERT #: e N 1.
BUSINESS NAME: �. u
QUALIFIERS NAME:
ADDRESS:
CITY: �r
PHONE (DAYTIME): 4/ tl 11
_ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE,(DAYTIME): I I
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
ST. LUCIE COUNTY CERT #:
ef
Pl'��P. STATE: L'�/c�ZIP le
3 FAX NO.
STATE:
STATE:
STATE:
ZIP
ZIP
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 RI BJECT TO ATTA HM NT• 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
STATE OF FLORIDA
COUNTY OF
I certify that all the foregoing information is
with all applicable laws regulating constru,
SIGNATURE
The foregoing instrument was acknowledged
before me this day of 6 20 61, by C'_61 t k t
5;W , who is personally known to me or who
has produced as identification.
Signature of Notary
'4tPh"ie L-Af _beg_
Type or Print Name of Notary
Notary Public _ Title
i
STATE OF FLORID
COUNTY OF 1
all work will be done in compliance
The foregoing instrument was acknowledged
before me this � day of 20_� by
L"Ewho is personally known to me
or who has produced as identification.
Signature of Notary 5�
haw) I e., L.
Type of Print Name of Notary
Notary Public Title
cc�f936� Commis=NCYTARY
9r13(o
R LCommission Number
ARBER(Seal) EOFFLORNA (seal). CC943630STEPHANIE L ARBER
XP. NE'8,2004 [NOTARY PUBLIC STATE OF FLORIDA
NOTE: COMMLSSION NO. CC4436,?a7TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NO} k .MISSIONE.XP: ,.MTE&
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPI!-�F
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
QFFICE
IJaS
ONLY
:.
'
SECTION:
TOWNSHIP:
.G
RANGE:
��
MAP NO.:
�h/
vL
ZONING:
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
R
LOT OF REC (befr 1/90)
LOT OFREC (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
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
SCHOOL
CREDIT'
Y
'
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FI E
MISC FEES:
'
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N.
ADDITIONAL
-
-
SPECIFY:
TOTAL ALL
PERMITS
FEES
REO'D
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE
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INITIALS