HomeMy WebLinkAboutApplication for Zoning ComplianceO�rIGEUSE.ONT,Y: � �
DATE FILED: �'��•
PLAN REVIEW FEE: " RECEIPT NO.: PERMIT NUMBER: �� f
CONCURRENCY FEE: RECEIPT NO.: CERT, CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
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_PLANNING & DEVELOPMENT SERVICES DEPAR'
BUILDIN�& CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. P�ierce, FL 34982-5652
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APPLIC
,'"ERTIFICATE 1
BUILDINGS PERMIT I
CITY/ZONING COMPL
PROJECT INFORMATION
LOCATION/SITE ADDRESS: B O' J. /iC i4iL% �p 9
PROJECT NAME: %n— � D d'T
PROPERTY TAX ID #: 44X- S /D D
SITE PLAN NAME:
ail,AAA- 6
4. LEGAL DESCRIPTION (attach extra sheets if necessary): AV
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.) �M LOT DIMENSIONS:
10. t COMPLETE DESCRIPTION OF(
11. SETBACKS (ACTUAL) FRONT:
162
PROJECT OR WORK ACTIVITY: J %r dl D
BACK: RIGHT SIDE: LEFT SIDE:
12. ® TYPE OF CONSTRUCTION (Check all appropriate boxes)
] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. f# DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION: 15. SF, FT 1st FLOOR:
16. 16VALUE 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 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
4 i
UPDATED 6/25/09
OWNER INFORMATION
NAME: -7-,0 S d 41AOC E ADDRESS: & 2®i S "'eut l Al2
CITY: F' STATE: ZIP:
PHONE (DAYTIME): d f — OVEntail:
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): (__
CONTRACTOR ONFORMATION
ST. of FL REG. CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME' : C___)
STATE:
FAX NO.
ST. LUCIE COUNTY CERT #:
Entail:
ZIP:
ARCHIVENGINEER: U l7 J_r A; C-�lU �EA21.[I��' �N `S'L�f� 4AJ V e '
ADDRESS: %D b S % TH ' S %
CITY: /--:r. P/ E/2C.!^ STATE: �L ZIP:Y 9.5
PHONE (DAYTIME): ( y %D� ` 1795
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.
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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 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: 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.
MR OR CONTRACTOR SIG ATURE
STATE OF FLO
COUNTY OF
The foregoing instrument was acknowledged before
me this day of 20 < .
by tS t1�
who is personally known or has produced
. as identifica
-.
Signs re of Nota
Commission No. (Seal)
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowle4ge'd before
me this day of
by
who is personally
of Notary
No.
20 ,
or has produced
as identification.
(Seal)
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/BUIII.DER APPLICANTS. '
For specific in: traactions see appropriate permit checklist.
01M CE USE ONLY #:
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
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)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
:FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
'.SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIREIEMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF
ELECTRIC GAS
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
Q.� • 3•I
DATE
COMPLETED
• I3'
INITIALS
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