HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
1. LOCA
E�OUNTY PUBLIC WORKS
ILDING 8, ZONING DEPARTMENT
2300 VIRGINIA AVENUE
OR10Q' FORT PIERCE, FL 34982-5652
561.462-1553
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APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
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2. S/D NAM 6������s�M9ITE PLAN NAME: /
3. PROPERTY TAX ID #: d'
4. LEGAL DESCRIPTION (attach extra sheets if necessary): �e Q Jl t (� C kriQ OI
5. PLAT 6. PAGE 7. BLOCK 8. LOT �j�/j�
BOOK NO. NO. r� NO. ( 0
r
9. PARCEL SIZE: ACRES/SQ FT. NIN LOT DIMENSIONS LIN
x 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: R(a MU -I) 2U. e� L D
�Nfa �OPtUR�uC� �r���
11. SETBACKS (ACTUAL) FRONT: t BACK: RIGHT LEFT
ivy Z�L SIDE �_ SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ j NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
Wgw1;J�
NA
[ I EXPANSION/ADDITION [INTERIOR RENOVATION
[ta/COMMERCIAL [ I INDUSTRIAL
13. DESCRIPTION OF PROPOSED USE: 'OWAC Ave re 5,4"le-5 tScf'- / Nip
14. Sq. FtMONSTRUCTiON: Z 2 15. Sq. Ft 1st Floor.
16. VALUE OF CONSTRUCTION: $ no
The value of constrvcaon 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 value of ovatruction if it is demonstrated that the submitted figures are not consistent with similar types Of construction activitias. If the value is $25rij
or more, a RECORDED Notice of Commencement must be Submitted with this application.
SLCCDV Form No.: 001-02
THE AVERAGE PROCESSING TIME FOR R40ST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME:
ADDRESS: '5:5-0�5
Y��]cTJ•CRJ, .l iLa r•�PUUf-Cc7 (C vy-fi�
CITY: "�yGi%1 el �/ �t STATE: /-�/a- LP
(rO
PHONE (DAYTIME): "6 -
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: j..4- j 1'J L
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME):
CONTRACTOR INFORMATION _ Q
ST. of FL REGJCERT Y:y�<::ZG 3 p14.9 �/v0
`) ST. LUCIE COUNTY CERT 0:
BUSINESS NAME: 1'C
QUALIFIERS NAME: TY�C� �IZT 1 V V'�a rfJ h
ADDRESS: i d p Z �-�C� /1/� �,�� �•� �i �y ������
CITY:STATE:
ZIP
PHONE !DAYTIME): ( I1 Co .� i - 6 �j' �/ x' FAX N0.3Z ( - 3 S ) •%
ARCHITIENGINEER:-�lT��/19r¢N /. JELL-�jtlljOiSl7� f ///
ADDRESS: % �/U 5 C-t� , �,�L�-% iA/ S YO W N <c G U�t• • (,/ / TC� ,•,r' CITY: Rue'?,ep, / `�_ STATE: �G� ZIP 37 i FG.
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER: J�'li ti�f
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.
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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 GIJB ECT 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.
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.
O EA/CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF _
The foregoing
fo lme this,
who
has oroducedl
of Notary
acknowledged
, 20�L2, by
i to me or who
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing i strumen�vas acknowledged
this day of ��Q"C 20 � by
�Gglse� lug who is{�ersonally known to me
or rho has produced CJUid>bntification.
Signature of Notary
Type or Print Name of Notary Type of Print Name of Notary
Notary Public Title Notary Public Title
Commission Number Commission Number
(seal) — (seal) OFFICIAL NOTARY St;,
IRVIE F. SAUNDERS
NOTARY PUBLIC STATE OF FLORIDA
NOTE: TWO (2) Sj T' �pp�y h�h CO"'SSiON�® CC763529
g S - 4Y' Q EACH SIGNATURE MUSTBJ jMq;TARJZED �r�
IF APPLYIN�-FOTH�I BUILDING PRMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAF
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
BP #:4/D/D0A `/
OFFICE USE ONLY
SECTION:
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
LAND USE:
_.-� /I�
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
V
OCCP TYPE:
MAX. OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF (be61/90)
LOT OF REC (aftr 1190)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLDG
HABITABALE
RADON FEE
ti
CODE
o
VVV
IMPACT FEE
AREA
(RADON)
Y
N
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
Y
N
SCHOOL
CREDIT
-
TOTAL
IMPACT FEE
!
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICEIFIREI
MISC. FEES
Y
NEL
ADDITIONAL
PERMITS
SPECIFY:
EE ��V'
TOTAL ALL
FEES
REQ'D
1
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
COMPLETErS
(, ' oV -
),-/- Ci I
INITIALS'I
-.� L.
✓W o
3
OFFICE USE ONLY: h
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: Q «
.JUE o�y
OUNTY PUBLIC WORKS
_ p ILDING 8 ZONING DEPARTMENT
C' 2300 VIRGINIA AVENUEa
�OR10Q' FORT PIERCE, FL 34982-5652
561462-1553
`�.,+
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: YZ y9 S- '6w�7 F7 57- L u C/
2. S/D NAME: SITE PLAN NAME:
3. PROPERTY TAX ID#: 3�1[`1 Sol- 1�b`i - 3aa�� (�7?���'
4. LEGAL DESCRIPTION (attach extra sheets if necessary): --5ce. Ct Jl-t at kk G1
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT._ LOT DIMENSIONS 4
x 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: RL MO
iwieQ f4PPLiRAuC�5
11. SETBACKS (ACTUAL) `'. FRONT: �( BACK: np RIGHT _f^ LEFT
_LY� L`1� SIDE _1 A f — SIDE:
12. TYPE OF
[I NEW CONSTF
[ ] RESIDENTIAL
[ ] OTHER (SPEC
13. DESCRIPTION OF
npriate boxes)
[ ] EXPANSION/ADDITION [9KINTERIOR RENOVATION
[t.]ICOMMERCIAL (] INDUSTRIAL
14. 3q. FUCONSTRUCTION: J1 2 % 15. Sq. FL 1st Floor
16. JALUE OF CONSTRUCTION: $ CYJd. ov ft/111
701
The vain. of construotion is used to determine the amount of `U � ird)q submitted
fees to be assessed. SL Luae Cau
n ht to question and/ modNy)R(e
die
Ralue of construction if it B demonstrated that the sutxnrtted figures are not consists with sknllar. n activities. H the value k S
or more, a RECORDED Notice of Commencement must be submitted with this application. \p
SLCCDV Fonn No.: 001-02
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMA LION:
NAME:
ADDRESS:
CITY: _f�AGsvI C°� Ty
PHONE (DAYTIME):
STATE: FL.4 ZIP
��� „2,�6 _ �C� �jC�
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADORE;
BELOW.
FEE SIMPLE TITLEHOLDER:,
.ADDRESS:
CITY:
PHONE (DAYTIME):
STATE:
ZIP
\V/ CONTRACTOR INFORMATION
/( ST. Of FL REGJCERT S: ��D
ST. LUCIE COUNTY CERT #:
BUSINESS NAME:_ 1"C -� ��pX I PSS<OC
QUALIFIERS NAME: za EIZT �T 'T
ADDRESS: (C--,
CITY:c
PHONE (DAYTIME):
ARCHMENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
zo
u_azL- 99s-S
U
1728411
t �uK��gy
STATE: �L _ ZIP
FAX NO.3a I- (P35) 7((.
O�
E�nl<c 3CC) s(,p
STATE: �L� _ yP 37 O
STATE:
STATE:
ZIP
ZIP
IMPORTANT NOTICE: When a permit is issued and It is not picked up Within 60 days
after notification it will be yo__ided and returned to you by mail.
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