HomeMy WebLinkAboutApplication for Zoning Compliancec v
DATE FILED / o - oSJ' DTI S� �1
PLAN REVIEW FEE:. S '0 D RECEIPT NO.: (1(9 a 7 PERMIT NUMBER: U�+ /
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL FO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
�E.G
- St. Lucie County Building and Zoning
2300 Virginia Avenue
�OR10P +` Ft. Pierce, FL 34982-5652
772-462-1113
APPLICATION for BUILDING PERMIT Recd
CERTIFICATE of CAPACITY/ZONING COMPLIANCE �,, % g M
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: LEA-?��CV` V 4` !
2. PROJECT NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #: q 511 "' 5 D o /3 a Q c o
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. L•OT NO.
9. PARCEL SIZE ( R$SIIQ FT.): - C` k: LOT DIMENSIONS:
10. COMPLETE DESSCRIPrTION OF CONSTRUCTION PROJECT ORr WORK ACTIVITY: 34) 1 i ve-ele-
11. SETBACKS (ACTUAL) FRONT: P4 BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE -OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [I INTERIOR RENOVATION
[, RESIDENTIAL [ ] CO ERCIAL [ ] INDUSTRIAL
[ OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $ ! (f/ bco
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
Received
OCT 2 8 2001
OWNER INFORMATION f` ` ERD
NAME: j E 61 �'
_ADDRESS: /b
CITY: Te-VVS-fyn ?x17cQ( ,, STATE: 11 ZIP:
PHONE (DAYTIME): (� 6 d DEmail:.
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 INFORMATION ?
ST. of FL REG.CERT #: C—�. ST. LUCIE COUNTY CERT #: 'T
L
BUSINESS NAME:C L�
QUALIFIERS NAME: K . 1 1 CZ
ADDRESS: �..��. �!
CITY: FT '?I -(- (C C- STATE: �
PHONE (DAYTIME): (1�4- IGG �� FAX NO. -7-72- 4' 2c' mail:
ARCHIT/ENGINEER:
ADDRESS: 1 1
CITY:
PHONE (DAYTIM ):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
ZIP: 3 4 4� T
C.� 611 STATE: �L_ ZIP:-
ONA
STATE:
STATE:
M1
ZIP:
EWPORTANT 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.
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
'APPROVED
LOT SPLIT
REPORT
CODE
HEABITABLE]
AREA
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC'BLD'
IMPACT
FEE
PARKS
IMPACT
FEE -
IMPACT
FEE
IMPACT
FEE
IMPACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVE
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY AV39CHANIC
SUBS
ROOF
ELECTRIC GAS
NON -CONFORMING
LOT OF RECORD
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
u/s
INITIALS
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 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.
The foregoing instrument was acknowledged before
me tfh��is�� day of d'D ? LO sal^ 20Od'` ,
by i4AM 0 f t to \�b he.
who is personally known v or has produced
�
asidentification.
/4 ``r
Signature of Notary
I
CdNYRACTOR SIGNATURE
STATE OF FLORIDA .
COUNTY OFG l
The foregoing instrument was acknowledged before
me this j d�a�yof"{� , 20 02,
by ` 11V 1 l l fJ�VV�
who is personally known _)C or has produced
of N
as identification.
ROBERT L. MOLE OR. U . W V C=jdS*" Expm Jim 30.
Commission No. ��Pa Commission No. =�, 4 S6� nft*n N DD 11685T
ARY PUB[1cvF NEW JERSEY F °:` ` B(OndE�d gy NaUonel Note A!
" MY COMMISSION EXPIRES JAN.18,2009
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.