HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED: PLAN REVIEW FEE: �/ D�� RECEIPT NO.: PERMIT NUMBER: /O/OD
��ec 'Ib1bDb�
ST. LUCIE COUNTY PUBLIC WORKS '
BUILDING 8r ZONING DEPARTMENT
® 2300 VIRGINIA AVENUE
�OR10Q' FORT PIERCE, FL 34982-5652
561462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
LOCATION/SITE ADDRESS: FL OR/OA 7-i1R1V`P/ KF
2. S/D NAME: SITE PLAN NAME::
3. PROPERTY TAX ID #: / 330-331-Oo0/- 0Oo�/ (LO�/is e
4. LEGAL DESCRIPTION (attach extra sheets if necessary): SEE ATTACHED S V R v E Y
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
2 673 x 1,32q X 2,673'x
9. PARCEL SIZE: ACRES/SQFT. 81.v5 ACRES LOT DIMENSIONS `SEE SURVEY
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: OFF PREMISE SIGN
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
2Sr 14268' SIDE 1 65t/1 SIDE: G%79
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
(" I' NEW CONSTRUCTION [ j EXPANSION/ADDITION (J INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ j INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: ADV ERT I SuQ& SI &N
2 SIGN P,4C'ES AT �J / /GTAL
14. Sq. FUCONSTRUCTION: 3-72� SQ • GT EA- 15. Sq. Ft 1st Floor.
16. VALUE OF CONSTRUCTION: $ 2 5 ODO.
The value of construction is used to determine the amount of permit fees to be assessed. SL Lude 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 $2500
or more, a RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME: OLC , INC.
ADDRESS: POST oFF1eE I3oX /L/0/9
CITY: GT. PIERCE STATE: FLORIDA zip 3L1974-4o19
PHONE (DAYTIME): (56I 14 614- 5977
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
SAME AS A13oVE
STATE:
ZIP
ST. of FL REGJCERT #: ES 000007 4 ST. LUCIE COUNTY CERT #: l 8 6 2 Z
BUSINESS NAME: EL L En? ('OM PAiV y
QUALIFIERS NAME: M l G U EL M A RTI AJ E 7,
ADDRESS: 520o /\/. W. 77 e0JRT
CITY: MIAMI e STATE: FLORIDA Zip 33166
PHONE (DAYTIME): (305i s9 2' 6 2 5 O FAX NO.(305) 6 L/O - % 4 6 2
ARCHIT/ENGINEER: CG R C EN 6r/AJ EE R) ti G- lot / A/ C .
ADDRESS: S 5 L/ 4 W. I Li 7 57 R EET"
CITY: CAK FOREST' STATE: TLLIA/OIS Zip 60Li52-
PHONE (DAYTIME): (log) 421-oyoo FAX : (-70$) L.( $q-9380
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
ONE
STATE: • ZIP
NonVE
STATE: ZIP
IMPORTANT NOTICE: When a permit is issued and it is not. picked up within 6060dav=
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 tha^
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 nor
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 allBJECT 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.
40PO4NTRAICTOR SIG RE -
O TOR SIGNATURE
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF/141,gInt-D4a6- COUNTY OF,_i� ?!^/
The foregoing instrument was acknowledged
before me this;" day ofOC �- 200 u, by jLt 6vec
MAkT' m C --, who is personally known to me or who
has pr duced FL • D k L i C as identification.
�IV63S-SYu- 'YJ-oY6-v
Signature of Notary
DA-VrD Cq0L,4K
Type or Print Name of Notary
Notary Public Title
The foregoing instrument was acknowledged
before me this j Y day of Q FC .20 bymt b uCL,
MAIeT/wEL who is personally known to me
or who rod d FL. /5'e a cas identification.
14 sYo-vi oY6-v
Signature of Notary
Type of Print Name of Notary
P�S�3 Zg� Commission Number
ge W329F
DAVID CHOLAK
Commission Number
(seal) NOTARYPUDM STATEOFFLORIDAMI
) COMMISSION k CC9S329S
DAVID CHO LAK
(seal) NOTARY
ExPSRS IV21R004
BONDED THRO Au 1-98&NOTARY,
PUBLIC -STATE OF FLORIDA
COMMISSION * CC9W9S
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH
SONDE()
THR "PMEA��-H�OTARYI
SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS
TO SIGN THIS APPLICATION IN THE OFFICE
AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAF
LISTED
ON THE FRONT OF THIS APPLICATION.
BP #: fib l
OFFICE
.USA
ONLY',
SECTION:
20
TOWNSHIP:
RANGE:
MAP NO.:
ZONING:
(`
LAND USE:
`O
LOT CVG %:
TAZ NO.;
FLOOD ZONE:
FIRM MAP #:
1 ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX.'OCCP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aft 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
EDIT
TOTAL ROAD
IMPACT ZONE
IMPACT FEE
IMPACT FEE
DUE
Y
N
SCHOOL
CRE
TO TAL
IMPACT FEE
''
SCHOOL
-
-
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
'-
TOTAL ALL
PERMITS
FEES
REQ'D
REVIEWS
F ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE
-Woo oo
0/-
INITIALS