HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED: ? -70
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: �(
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE 8r FILLED IN TO BE ACCEPTED
�JLy ST. LUCIE COUNTY PUBLIC WORKS
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BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561.462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1. LOCATION/SITE ADDRESS:
2. S/D NAME:
3
4
5.
9.
10.
i
11.
PROJECT INFORMATION;
a, s
PROPERTY TAX ID #: cv"7 d 7 c�o / e
LEGAL DESCRIPTION (attach extra sheets if necessary):
PLAT
BOOK
6. PAGE
NO.
7. BLOCK 8. LOT
NO. NO.
PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
DESCRIPTION OFT CONSTRUCTION PROJECTOR WORK ACTIVITY:
�-= eL-7' ( 1 aL1CL�, e, d`�`�/&, .
SETBACKS (ACTUAL)
FRONT:
BACK:
[ 12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ j NEW CONSTRUCTION
[ ] RESIDENTIAL
[ j OTHER (SPECIFY)
[ ] EXPANSION/ADDITION
[ ]s COMMERCIAL
RIGHT
SIDE
SIDE:
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
13. DESCRIPTION OF PROPOSED USE: el P.//Nib
14. Sq. FUCONSTRUCTION: 15. Sq. Ft. 1st Floor.
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 of construction if it is demonstrated that the aubmibed figures are not consistent with similar types of construction activities, U the value is S25W
or more. a RECORDED Notice of Commencement must be submitted with tlds application.
SLCCDV Form No.: 001-02
OWNER INFORMATION:
/�
NAME:
I
''C �l'l C
ADDRESS:
CITY:
STATE: "/ ZIP
PHONE (DAYTIME): ( I
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:
STATE: ZIP
PHONE (DAYTIME): ( 1
CONTRACTOR INFORMATION
ST. of FL REGJCERT t: T/`�. ,�/ '
BUSINESS NAME: 9t
QUALIFIERS NAME:
ADDRESS: —t
CITY:
PHONE (DAYTIME): Tu
ARCHITIENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
d l� STT./. LUCIE COUNTY CERT #:
STATE: l y • / ZIP
-71
STATE Zip
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.
ICERTIFICATION:
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 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, 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.
' r k,-7,
,
WNER/CONTRACTOR SIGNURE
STATE OF FLC , DA
COUNTY OF..
The foregoing in' trumen was acknowledged
before me this day of 201a, by
;who is pe a know' tome or who
as produced as identification.
Signature of Notary
ha
Type or Print Name of Notary
Notary Public Title
(_CC C_P11c7 Commission Number
or Trade L Lamb
(seal) my Commission CC905007
Expires January 25, 2004
CONT TOR SIGNATURE
STATE OF FLOIRID#
COUNTY OF
The foregoing,,'rstrument was acknowledged
before me this day of - , 20 d.3 , by
d. who is p ai11 known'bo me
or who has pr uced `"'"es1d6nVication.
Signature of Notary
Type of Print Name of Notary
Commission Number
r`'�a Trade L Lamb
(Seal) * * My Commission CC906M
'o,,V Expires January25, 2004
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERSUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OFFICE USE ONLY
SECTION:
TOWNSHIP:
3
RANGE:
4
MAP NO.:o
GJ'%
ZONING:
///���3
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l./(�J
LAND USE:
( Ya
�fl j'V
LOT CVG %;
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
yl.•
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCPTYP,Et.`
MAX. OCCP:
# OF FLRS:
%�
r
WATER'
EWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REO'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
REPORT
���55
PUBLIC BLDG
HABITABALE
RADON
CODE
_G
IMPACT FEE
AREA
{RADON)
ROAD
GROSS ROAD
CREDIT
Y
N ,
TOTAL ROAD
IMPACTZONE
IMPACT FEE
IMPACT FEE
DUE
Y N
SCHOOL
CREDIT
TOTAL
IMPACTFEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEES:
iz�2 '
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
REO'D
FEES
i
REVIEWS
ZONING
ZONING
PLANS VEGETATION
SEA
MANGROVE
REVIEWED BY
EXAMINING
TURTLE
DATE
COMPLETE _
INITIALS _