HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED: D 3'O
PLAN REVIEW FEE: RECEIPT NO.., tIZZ PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
IW p �E 0Gy ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT IC -
2300 VIRGINIA AVENUE
�OR10P FORT PIERCE, FL 34982-5652
561-462-1553
V APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESSJ,�Voo J( 4,r 13.1v,/ /y/n 62� FL- , 3:: 9
2. S/D NAME: iSITE PLAN NAME:
3. PROPERTY TAX ID#:Hs/25=�o3_om0i/=,'000�/
4. LEGAL DESCRIPTION (attach extra sheets if necessary)..5 «d
/Y- 15-D (/. /3 9 /
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. ��- / �/ NO. NO.
9. PARCEL SIZE: ACRES/SQ FT.-Y91 6/Y-f-f LOT DIMENSIONS 1
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: BACK:; RIGHT LEFT
„
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: Ce5 iC/SNTi',a Ton n Hw �y,., rr e},2 TV09
14. 5q. FUCONSTRUCTION: - f 9. 6 / S q/ 15. Sq. Ft. 1st Floor. I\t //6
16. VALUE OF CONSTRUCTION: $%/Hy
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 tht
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 $25C@
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:
Aizl'ki( /1cj".,.i4 Qo fs2 VWn/ft2s�:...6?SSec'i/� `" Mee.
ADDRESS:
I.7600 7'YA��-mat
fl`oP�V'
Qvo/'
..
CITY:
% A-'tn : may;..
STATE: L ZIP
.31/ 19 °
PHONE (DAYTIME):
1561 133 f — 3o o s;
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME
AND ADDRESS
BELOW.
FEE SIMPLE TITLEHOLDER: iv /1.
ADDRESS:
CITY:
STATE: ZIP
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REGJCERT #:
01I 1
ST. LUCIE-//CCOUNTY CERT #: 3 'Y
BUSINESS NAME: `
`}-SP
J (/�'
h w, /L2i'N)d
,/2eG osJ I -IV
�A-v �e
QUALIFIERS NAME:
`� R IZ i S,q-'✓
ADDRESS:
31% o
CITY:
��¢T
STATE: �L ZIP
3
PHONE (DAYTIME):
(S� II:. aZlf`iT— �2.5y
FAX NO. 561 - •2.S $- �2 �n 2
ARCHIT/ENGINEER:
EGP /i.-/oW�'. /`i-n<Fy—: �orzw�-� /7SSotrA- /-DES:.: •rv{
ADDRESS:
02,�/ D
.7 a
CITY:
s 1 %;R�
STATE: F— L ZIP
3 `%
PHONE (DAYTIME):--:"'�"'�IS"%i
��'�,- a l 9 0
AA
BONDING COMPANY:
/ u.
ADDRESS:
CITY:
STATE:, ZIP
MORTGAGE LENDER:
y�
�'V /(+
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.
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. 1 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 (ail 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 AN12
INTEREST THAT IS SUBJECT ECT 10 ATTACHMENTATTACHMENIG 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
/ with all applicable laws regulating const
OWNF�R/C NTRACTOR SIGN RE
/lrthAi: �' "'VOA-eY Gev Mb�
STATE OF FLORIDA
COUNTY OFF Z n a`JE `
The foregoing instrument as acknowledged. -
before me this � day of Was
20O_a, by L�1w=
NdAR , who is personally kno-wn to me or who
has produced a/� u°as identification.
Signatunii of Notary
IS/,2 /LoC -
Type or Pri t Name of Notary
and that all work will be done in compliance
zoning.
SIGNATURE
STATE OF FLORIDA J
COUNTY OF >`:, e a J
The foregoing instrument Was acknowledged
before me this.-,this.-,L day of d.V4! . 20 n by
, who is personally known to me
/or who has produced as identification.
Signature to
Type of Print Name of Notary
Notary li Title Notary Public Title
Cartissimn Number
Commis i ber MAxGYBARz
* *My Commission CCO83714 47 � �^y, w c MY COMMISSION#CC936S96
(seaCy,
Expires September28,2007 (seal) ��orit0e EXPIRES: May15,28M
1900.'i-NOtASY FL Notary SeMce&Bor,ping, lrw:,
NOTE: TWO (2) SIGNATURES ARE REQLNttE-I� : SIGNATURE MUST BE NOTARIZED,
IFAPPLYING FOR THIS BUILDIN' .P1E A, AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEA
TO SIGN THIS APPLICATION IN THE r , E LISTED ON THE FRONT OF THIS APPLICATION.
BP #:C:2I DD�I
OFF�CEi USE ONLY'
SECTION:
_ /�
TOWNSHIP:
—:5/y '"- ,
RANGE:
/! D
/
MAP NO.:
ICJ
ZONING:
/ / j ')
`.''
LAND USE:y
c.'
LOT CVG %:
''
TAZ NO.:
FLOOD ZONE:
, '�
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
.ISA)C:.00CP:
# OF FLRS:
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aRr 1190)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
"'FEE
REPORT
PUBLIC BLDG
HABITABALE
N FEE
CODE
.�
IMPACT FEE
AREA
(RADON)
Y::;
IN
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
POLICE/FIRE/
MISC. FEES
Y N
ADDITIONAL
SP CIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
1 i
REVI'WS
ZONING
ZONING
PLANS.�1/EATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE
INITIALS