HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED:l—D3 D I
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: (�-kZ
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
YPO a) a 1 D (o3. � d
��e c . ocol
ST. LUCIE COUNTY PUBLIC WORKS 1 ooa.g3
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
�DRWp FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 420RIDA TvRn P1 ffE
2. S/D NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
SITE PLAN NAME:
SEE ATTACHED SVRyEY
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
�g•95 �]C/�ES 6syrX 1,323 (057X
9. PARCEL SIZE: ACRES/SQFT.
LOT DIMENSIONS 1,325(5rE 5u,2vE'x)
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: OFF PREMISE SIGN
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
251 I1262- SIDE 58 SIDE: 555r
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[vf NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: ADV ERT I sm)& SIGN
2 SI GAI FACES AT yy S �ara�
14. Sq. FUCONSTRUCTION: 3-72T S4. FT. EA. 15. Sq. Ft 1st Floor.
16. VALUE OF CONSTRUCTION: $ 2 S 000.
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 modf' the
indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activitles. If the value Is f2500
or more, a RECORDED Notice of Commencement must be submitted with this application. car
SLCCDV Form No,: 001-02 �` ��
0d
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
OLC . /A/C.
POs-' oFFiCE /Sox /YO/Q
FT PIERCE STATE: FLORIDA Zip34979-4oIQ
(5611 Ll611-5977
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: SAME AS A+BOVE
ADDRESS:
CITY: STATE: LP
PHONE (DAYTIME): I 1
CONTRACTOR INFORMATION
ST. of FL REGJCERT N: ES 00,0007q ST. LUCIE COUNTY CERT #: / 8 6 Z 2.
BUSINESS NAME: EL L ER M EEO 1A C'ONl PAiV V
QUALIFIERS NAME: M l G U EL M A R T) N E Z
ADDRESS: 5-800 N.W. 77 eOURT
CITY: MIAMI STATE: FLORIDA Zip 33166
PHONE (DAYTIME): (3o5i 59 2 - 6 2 5 O FAx NO. (305) 6 yo - / 9 6 2
ARCHIT/ENGINEER: Ij R C EN 6T/IJ EE R I A-) G lot / A/ C .
ADDRESS: 55Li 41 W. IH-7 57REET-
CITY: 0A)(' FoREST- STATE: TLL)n/0IS Zip 6OLI52-
PHONE (DAYTIME): (709, NISI-OLloo FAX : (70$) y g9-95&0
BONDING COMPANY: NON E
ADDRESS:
CITY: STATE: • ZIP
MORTGAGE LENDER: N ON E
ADDRESS: - -
JITY:
STATE: ZIP
IMPORTANT NOTICE: When a permit is issued and It is not. picked up within _AUMS
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 aU13ECT 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.
CO RACTOR NATURE
STATE OF FLORIDA
COUNTY OF M1410
The foregoing instrument was acknowledged
before me this day of DE C 20 Lo, by 111 &uEL.
Mq�r7lLEZ , who is personally known to me or who
has pr duced GC c/C- as identification.
/� Ft�l63S-5Yo- y7-oyb-o
Signature of Notary
L)4V I CI4yA't
Type or Print Name of Notary
Notary Public Title
STATE OF FLORIDA
COUNTY OF M I ql I r - 74 D c
The foregoing instrument was acknowledged
before me this i y day of 0 E e , 20 .- by Al I Gu 6 C
M/I ,Q r"�/ V— —,- who is personally known me
or who has produce L. 41•6C as identification.
� � f*2/655-�L/o Y)•oY6-o
Signature of Notary
L l-f L,4 k
Type of Print Name of Notary
CC �7�' ' Commission Number PP 983 2 96
DAVID CHOLAK Commission Number
(seat) NOTARY PUBLIC- STATE OF FLORIDA DAVID CHOLAK
COMMISSION # CC983298 (seal) NOTARY PUBLIC - STATE OF FLORIDA
EXPIRES 112M2084 COMMISSION # C09M298
BONDED TNRN ASA 1-888-N0TARYI EXPIRES 1101=4
UONggp TI4Ru AAA 1 AS"OTARYI
URES ARE
hr)TE: IF
PLYING TWO
OTR THIS BUIILDINGU ERMITEAS AN SIGNATURE
THENOTARIZED.
OWNER MUST PERSONALLI
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. APPEAF
OFF�CE.,USE
O
SECTION:
TOWNSHIP:
RANGE:
ZONING:i�
LAND USE:
LOT CVG %:
FLOOD ZONE:
FIRM MAP #:
1 ST F.,,.,.LRzi
CST TYPE:
OCCP TYPE:
MAX. OCCP:
WATER:
_.
SEWER:
SPRINKLERS
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/9D)
LOT SPLIT
REO'D
DECAL
NUMBER
LIBRARY
IMPACT FEE
PARKS
IMPACT FEE
REPORT
CODE
PUBLIC BLDG
IMPACT FEE
HABITABALE
AREA
(RADON)
ROAD
IMPACTZONE
GROSS ROAD
IMPACTFEE
DUE
_ r
'DIT
SCHOOL
IMPACT FEE
CREDIT,:
Y
N
POLICE FEE
FIRE FEE
MISC FEES:
ADDITIONAL
PERMITS
REO'D
Y
N
SPECIFY:
REVIEWS
ZONING
ZONING
REVIEWED BY
PLANS
EXAMINING
DATE
COMPL9TE
�(f-�•{j �
INITIALS
(� \
BP #:-
3o
MAP NO.:
TAZ NO.:
MAX HGT:
# OF FLRS:
STORMWATE
R
LOT SPLIT
APPRV'D
PERMIT
FEE
RADON FEE
Y N
TOTAL ROAD
IMPACTFEE
....<:._.....,.... ��'.
TOTAL
SCHOOL
IMPACT FEE
TOTAL
POLICE/FIRE/
MISC. FEES
TOTAL ALL
FEES
VEGETATION I SEA I MANGROVE
TURTLE