HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
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�� Ie c0oy ST. LUCIE COUNTY PUBLIC WORKS
` BUILDING & ZONING DEPARTMENT
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2300 VIRGINIA AVENUE
'20R10p' FORT PIERCE, FL 34962-5652
561462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: FL 01elDA 7%1R1VP/ KF
2. S/D NAME:
SITE PLAN NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary): !SEE ATTACHED Sy R v E Y
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
'-116 3 g' x I, 3 2 5' x 'i, 6 -3
9. PARCELSIZE: ACRES/SQFT. /W-3o ACRES LOTDIMENSIONS 1 32T ACC SI/2IJEY)
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: OFF PREMISE —t&Aj
11. SETBACKS (ACTUAL) FRONT: BACK: r RIGHT LEFT
25 264 SIDE 2a$76 SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[� NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: ADV ERT I SING SIGN
2 SIGN FRCES AT
14. Sq. Ft/CONSTRUCTION: 3-7$ SQ. F-r EA. 15. Sq. Ft 1st Floor. 77r"-qz I-T-6
16. VALUE OF CONSTRUCTION: $ 2 S, OOo.
The value of construction 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 construction N it to demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value Is $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02 1
f
D o
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME: OLC , 1AIC_
ADDRESS: POST OFFIeE F3oX /Llo/(?
CITY: FT. P/'EwCE STATE: F'LORIbA vp3y974-401Q
PHONE (DAYTIME): L561 i L16 Li - 5977
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: SAME AS A$OVE
ADDRESS:
CITY: .STATE: ZIP
PHONE (DAYTIME): { 1
CONTRACTOR INFORMATION
ST. of FL REGJCERT#: ES 000007q ST. LUCIE COUNTY CERT#: /867-2
BUSINESS NAME: ELLE/2 MEEO/A C'OAPAiV/
QUALIFIERS NAME: M 16 U EL M A P TJ Al E Z
ADDRESS: 5-800 hl. W. -77 eOyRT
CITY: MIAMI STATE: FLoRID.A ZIP 33166
PHONE (DAYTIME): (3051 59 2 - 6 2 S O FAX NO. C30S� E, �/O - Q (0 2
ARCHITIENGINEER: G R C EN CsiA1 EE R I ti G- / A/ C,
ADDRESS: 5 S q L/ \-J. I H-7 5T R EET
CITY: CAI<' FoPEST- STATE: ZLL)NOIS Zip 6O'i52
PHONE (DAYTIME): 170g) y S q " 0 y O0 FAA 6-7 0 S) y $q - 9 38 o
BONDING COMPANY: N ON E
ADDRESS:
CITY: - STATE: • ZIP
MORTGAGE LENDER: N ON E -
ADDRESS:
CITY: STATE: ZIP
IMPORTANT NOTICE: When a permit is issued and it is not, picked up within 6® day-=
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 concurency 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.
CONTRACTOR SI TURE
STATE OF FLORIDA
COUNTY OF . Y/i.4aa/ - 0 40E�-
The foregoing instrument was acknowledged
before me this / .. day of &c' c 20 oo, by; L/bLIEL
MARTi n 6v who is personally known tome or who
has uced I-L -216f1l a as identification.
Signature of Notary
Type or Print Name of Notary
Notary Public Title
STATE OF FLORIDA
COUNTY
The foregoing instrument was acknowledged
before me this /Y day of DEe 20. by-%iG!/Ec
vh. n Ez who is personally known to me
or who has pro uc d Fr on' ti c as identification.
Signature of Notary
Type of Print Name of Notary
c y 321' Commission Number C'N9k3 z 9 j�
Commission Number
DAVID CHOLAK DAVID
CHoLAKseaqNOTARY PUBLICSTATEOA NOTARY PUBLIC
COMMISSION Ca298 (seal) -STATEOF F<
OR&"'AES 12004 OOM�8NSEpS>98BONDED TRRU AqA 1-888-NOTARy1 ND11R1r4NORU ASA 1-88g.HOTARYi
CH
GNATURE
NOTE: IF APPLYIING FOR THIS BUILDING 2) SIGNATURES ARE OU ERMITEAS ANIOWNER/BUILDERMUST BT THE MUST PERSONALLY
APPEAF
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
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