HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED: tit e6 Ol g
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER-�Q/D� /
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
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ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652
561462-1553 P
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: tF /n A0 .f _ 1 P � T �, 4 S4 , L z G L 3 4
2. S/D NAME: Sip� : < < L o.jr a_ s -0 I SITE PLAN NAME:
3. PROPERTY TAX ID#: 11�Q-Z' kc Iz- Psr,.i +i 3v14. of - 170t
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS s'v ' x I Do,
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: a C7 3 fJ z
Cmow."r-L" S,A� -. :'�k
11, SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
(] NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
14. Sq. Ft./CONSTRUCTION: 3 ti '3 4 + 2 15. Sq. Ft. 1st Floor: Z 93 SG
16. VALUE OF CONSTRUCTION: $ /I 9 -C-0
The value of construction 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 0 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
I THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME)
STATE: FLL
331&p
34449+
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):
STATE:
ZIP
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: RAJ ST. LUCIE COUNTY CERT #: B 3 Z 3•y
BUSINESS NAME: _� n „ap l.,a•n c, r eA z Pi w., r, i Sin
QUALIFIERS NAME: C3_u_6_it, p_ T. F.�r
ADDRESS: S 31 O Pa.11, Dr.
CITY: 1=4 • P i elcR. STATE: L ZIP 3y 9 g 7
PHONE (DAYTIME): (rb )) H b% 4 6 6 4 FAX NO.
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
AJ/
a
STATE:
STATE:
ZIP
ZIP
MORTGAGE LENDER:
ADDRESS:
Cm:
e
STATE: �__ ZIP
IMPORTANT
�`OTACE: When a
after notificati)n it will be Permit IS issued and it vo— �dd and returned to AS not
Puked
You by mail. up within 60
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 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.
OWNER/CONT ACTOR SIGNATURE CONTRACTOR SIGNATURE
STATE OF FLORID
COUNTY OF
STATE OF FLO IDA
COUNTY O 6l-��
The foregoing ins w s acknowled ed The foregoing instrume acknowledged
before me thi r day i�, 2�, by / -- before me thi�� o c 20 D , by
who is personally nown to me or who ijQggi� Ffit?ly�rii�P�ff who is pe onally known to me
has producedE;V L2 as identification. or wh has produced FZ_44��as identification.
1 Signature of Notary Siena ure of Notary �y
�i
Type or Print Name of Notary Type of Print Name of Notary
Notary Public Title Notary Public Title
Commission Number Commission Number
p�"'Z,.^''ir, Kathleen ciclo
(seal) % Kathleen Cicb (seal) *IV* My commission CCSSW82
Q* My commission CC959482 N., „p� Expires August a, 20g4
o,n/ Expires August 8, 2004
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
lE APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAfi
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
a �.
OFFICE USE ONLY
SECTION:
_ /
TOWNSHIP:
/
Y�
RANGE:
�? CIL�
MAP NO.:
/
/V
ZONING:
r'
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SE
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aft r 1/90)
LOT SPLIT
LOT SPLIT
REQ'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
Y
N
" ''' ~
SCHOOL
CRED
TOTAL
IMPACT FEE
SCHOOL
-
IMPACT FEE
POLICE FEEA
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONALSPECIFY:
---®,�„`
TOTAL ALL
PERMITS
FEES
REQ'D
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE
INITIALS