HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLI': ' I
DATE FILED: `-1 4 4 f %�
PLAN REVIEW FEE: o` RECEIPT NO.: PERMIT NUMBER: I �/
CONCURRENCY FEE: `r RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION D
2300 Virginia Avenue c�
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 9 q 0 q S. V"I;y-
2. PROJECT NAME: iJ4-pO L E SITE PLAN NAME:
3. PROPERTY TAX ID#:-
4. LEGAL,PESCRIPTION (attach extra sheets if necessary): /g 3(0 q® S 1 5;1,pr- �� N 7$•
4F S % 2 00. L07 41 4L ow'-- FL c 4lz Cy/L /3.-s 9l0 z 539- 23��)C`�4
5. PLAT BOOK 6. IPAGE NO. 7. BLOCK NO. 8. LOT NO.
I
9. PARCEL SIZE (ACRES/SQ FT.): 2.26 4CR-45LOT DIMENSIONS: lg�P/1� d� ?
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: ,T�LNJD S�/wLo
11
12.
13
SETBACKS (ACTUAL) FRONT:—___---
F •'
TYPE OF CONSTRUCTION (Check all appropriate boxes) f
[ ] NEW CONSTRUCTION
RESIDENTIAL
[ ] OTHER (SPECIFY) _
RIGHT SIDE: 5 1 - b
EXPANSION/ADDITION [ INTERIOR RENOVATION
] COMMERCIAL [ ] INDUSTRIAL
DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION: 83 9
15. SF. FT I st FLOOR:
113 0
7
16. VALUE OF CONSTRUCTION: $ a� v
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie Coes es the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent with;siinilar typction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted4 with qs application
SLCCDV Form No.: 001-02s
r',
UPDATED 6/25/09
71)
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OWNER INFORMATION
NAME: s.�ld� X--7. U%%t�
ADDRESS: 6q0 q S, -7;vo01f 4 / �i V 04-l vG
CITY: klf� ! �84� STATE: AL ZII': -3 f eZ
PHONE (DAYTIME): 1741 9 q d S/* Z Email:
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 (DAYTRVIE): U
CONTRACTOR INFORMATION
STATE:
ST. of FL REG.CERT #: CGCd��5-05, "79 7 ST. LUCIE COUNTY CERT #: ;7-
BUSINESS NAME: Af 7" t'�/�tG�� �yS P%a°� we- -
QUALIFIERS NAME: `l-OT50✓A
ADDRESS: �O ��®it Zq71
&AL
CITY: ✓reow '6ewraw STATE: A
PHONE (DAYTIME): T( 7Z) `17 3 5 110 FAX NO. 77Z S-&'? A SZ /
ZIP: Z quo
Email: ,/4y 60 �/L/ •ECp ,E'.L9/ ,v.
�u
ARCHIT/ENGINEE/�R: ClxiY� W-�A•4-eZ 7�G7TJ2
ADDRESS: 0[Y ,� �042� .41�
CITY: ) l , A `� - STATE: ZIP: mayfly
PHONE (DAYTIME): 07_4 �j 0 - 779i7/
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
ZIP:
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. 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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full cwncurrency 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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
STATE OF FLOR11DA
COUNTY OF . ) VA.P�
The foregoing instrument was acknowledged before
me this 1�2?4 day of 20�
by
who is rsonally known or h produced
'-as identification.
RignatQ a of Notary
oti'RYP�b'�, LAWN [ALONE
_ , , c ; N. ?,LaQuhlic - State of Florida
Commission No. n • • My om .Expires Mar 22, 2017
Commission # EE 877571
!%° F� „�'��� Bonded Through National Notary Assn.
Cie
STATE OF FLORID
COUNTY OFF-�-�
The foregoing instrument was acknowledged before
me this day of 20
by
who is personally known or has produced
Las identification.
DAWN MILONE
l�pY Pv �•y,
;.moo Nothry,friy state of Florida
Commission No. : My Corrlm`` x rres Mar 22, 2017
M�P;= Commission # EE 877571
Bonded.Through National Notary Assn.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #:
SECTION
TOWNSHIP
�%
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG % `7
%
TAZ NO.
FLOOD ZONE
X
FIRM MAP #
I ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
L —•
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
(RADON)
LIBRARY
IMPACT
FEE
PUBLIC BID
IMPACT FEE
CORRECTION
PUBIC BID
IMPACT
FEE
PARKS
IMPACT
FEE
G
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y N
LAW ENF
IMPACT
FEE
FIRE/EMS
IMPACT
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
FEE
_
SPECIFY
SUBS
MECHANIC ROOF
ELECTRIC GAS
NON -CONFORMING
LOT OF RECORD
MISCELLANEOUS
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
t� t
/
DATE
at
I
COMPLETED
INITIALS