HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY: 2
DATE FILED: D D3:D/�f/ O%QQo2�
PLAN REVIEW FEE: RECEIPT NO.:.�`7S� PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
J �e cop ST. LUCIE COUNTY PUBLIC WORKS IN
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE ,p�
FORT PIERCE, FL 34982-5652
20R\Oa 561462.1553
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APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
t Z d E l�l d 1��=� FL 3ti s9
LOCATION/SI/TIEADDRESS: j�Gea J7ruR�o " •,� d
S/D NAME: PG9P-Do..2.eks ec/T �-w y (i SITE PLAN NAME: r�%,21 , y eor it D.J #73
PROPERTYTAXID#: 6 3-000��
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LEGAL DESCRIPTION /f
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5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK
NO. ii° - -LI0' NO. NO.
9. PARCEL SIZE: ACRES/SQ FT.,1' • LOT DIMENSIONS [1
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT L"`EFT
SIDE 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: ES dri./li'9/ a Qnn H'Ay 'tiRr21"V4 /
14. Sq. FL/CONSTRUCTION: 'r�r �» 15. Sq. FL 1st Floor. se A
16. VALUE OF CONSTRUCTION:
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 o' construction if it is demonstrated that the submittedfigures are not consistent with similar types of construction activities. If the value Is $25®C
or more, a REC.RDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
THE AVERAGE PROCESSING TIME FOR MOST BUILDING PERMITS IS TEN (10) WORKING DAYS
OWNER INFORMATION:
NAME: ow i� y (lWi.in2s� /'YSSocI.�nN�e
ADDRESS: . L^2 6 o �f%�'F /J Lvcf
CITY: 71t�^� 1,� /'y STATE: ZIP
PHONE (DAYTIME): (.i 4 (1 33
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW. //�
FEE SIMPLE TITLEHOLDER: N / 7
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): I 1
CONTRACTOR INFORMATION
ST. of FL REGJCERT S: J5 ST..LLIUCIE COUNTY CERT #:
BUSINESSNAME: CKSTo h�.i��'.,.J J14Ri�y.,t- La�✓$.Kc'oN ,rjyc-
QUALIFIERS NAME: .�A-u ��c� Co 9:12 fA &-y
ADDRESS: 317 O SF, A�R9,LRr2
CITY: S-t K ra R-f STATE: F ZIP 3
PHONE (DAYTIME): 4561 1 t 8� fr— %'2 S'v FAX NO. 6/ - a 9-4^-- � ff
ARCHIT/ENGINEER: k U �M r vNv )V,4+ fv - /7'�RN -r` /�SSvc i A J, L
s rvf _
ADDRESS: -
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
STATE: ZIP
/ V IA -
CITY: �;.
STATE:
ZIP
MORTGAGE LENDER: rr
ADDRESS: -
CITY: STATE: ZIP
IMPORTANT NOTICE: when a permit is issued and it is not, picked up within 60
dag
after notl'Cation it will be XQide 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. 1 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 IJILE, AND
INTEREST THAT IS St to ICPT TO ATTACHMENT AS A CONDITIOWOF THIS PERMIT YOU
PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATrACHED CONSTRUCTION LIEN
LAW NOTICE TO THE PERSON WHOSE PROPERTY I& UBJECT TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is a to and that all work will be done in compliance
with all applicable laws regulating . n and zoning.
9WNER/CPNTRACTOR SIGN RE C RACTOR SIGNATURE
c riff N„arny J FIJ P?,Z
STATE OF FLQRIDA STATE OF FLORIDA
COUNTY OF 5y . t c ti COUNTY OF ;
The foregoing instrument Avas acknowledged . The foregoing instrument was acknowledged
Before me this � day of c. 2000
n _, by/ c%ryP / before me this � day of ;•: -.; ' , 20� by
who is personally knoyvn to me or who who is
has roduced k!/ l�da § identification. Personalty known tome
who has produced as identification.
11
Si�=Notary Signature o Qj
i2ka a4 /Z'lA!y A2Z
Type or P 'nt Name of Notary Type of Print Name of Notary
Notary Public L� Title Notary =1L_ Title
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NOTE: TWO (2) SIGNATURES ARE R€QU-
IF APPLYING FOR THIS BUILDING R R14tIT ASS ANIOWNERR/BUIL�ERBET OOWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
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