HomeMy WebLinkAboutApplication for Zoning Compliance9 Z) Fd fiz L)J
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DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County Building and Zoning
2300 Virginia Avenue
•'�(OR10P • Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1. LOCATION/SITE
2. PROJECT NAME;
3.
4.
PROJECT INFORMATION
I < a-Paln J)v, I �,- E3 I
SITE PLAN NAME:
PROPERTY TAX ID #: ;f - (1 — S / 0 — 6i '" n vv
II��GAL DESCRIPTION (attach extra sheets if necessary):
1CT✓er' -T-hr Lo+- 9'3I c
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE ACRE /SQ FT.): D' Q fo LOT DIMENSIONS:
-7 (O
10. COMPLETE DESCRIPTION Of CON TRUCTION PROJECT OR WORK ACTIVITY: (_ za, wA=
a k - -- r_r Z"/<
11.
SETBACKS (ACTUAL) FRONT: BACK:
RIGHT SIDE: LEFT SIDE:
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION,
[ ] . RESIDENTIAL [ ] COMMERCIAL
[ ] INDUSTRIAL
[ OTHER (SPECIFY)rjL
+/DESCRIPTION
J
13.
OF PROPOSED USE:
14.
SQ. FT OF CONSTRUCTION: T
15. SF. FT 1 st FLOOR: tj A-
d,6 b0
16.
VALUE OF CONSTRUCTION: $ U
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
'Receive
APR 28 009
ERD
OWNER INFORMATION
NAME: tf� IU / f °%i�/V'{ �' Q-�Y�Qr / J Q� �d P 7—�9 n
ADDRESS- •ZO;7olJo��1 ocraN Z ?. /-'U-r 8 3/'
CITY: U e /\i S e 61 A e // STATE: ao � i C C.- ZIP: 3/�
PHONE (DAYTIME): l C e. ` :3 7 4/- (- t 3 3 Email: �PSSC'►rV��IC%i`d.S / i�l�c
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): (a ep 3 l Al & / 3
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME: I t ( D
QUALIFIERS NAME:
ADDRESS: 2---O
CITY: tom-` 3 n Q K :e STATE:
PHONE (DAYTIME): (��-�M V FAX N0.
CITY: `P A)r1 �[L I JA
PHONE (DAYTIME): (322::
BONDING COMPANY:
ADDRESS:
CITY:
. W-e- k
YA-k rr- 44 _
S_T. LUCIE COUNTY CERT #: 0 I l
/ .,/y
0 �P lo(`"/ Email:
p STATE: ZIP:
STATE:
/lh
MORTGAGE LENDER:'
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. I certify that no work of 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 prolnbit 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 WrIIH 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.
OWNER OR CONTRACTOR SIGNATURE
STATE OF .FLORIDA
COUNTY OF ,�_ L t1 c
CONTRACTOR SIGNATURE
STATE OF FLORID Lr , ,, _ '
COUNTY OF R�
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this 7 day of V1r 20 �i , me this day of 20 bnl
by �• k l 1 �1 '►'Yl C by V� wit �QS
v@fio_ispersonaIIy known or has produced who is personally ]mown or has produced
as identification. as identification.
Signature of Notary
Commission No.,—�ie'�MdAIA� Commiss><� 0 O`l 2oarrP JDAWN FITZGERF
•, MY COMMISSION # DD4!
EXPIRES: December 1V
1419K-NOTARY Fl.NotaryDisrounlAss
/!'thhtt!.M1,Al.R9'a+'kscn`+.y.Atd'm
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 OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
Co.
OFFICE USE ONLY BP #: 6 91) y- _60a-q
SECTION
j
TOWNSHIP
RANGE
MAP NO.�
i I
ZONING
LAND USE
LOT CVG %n
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
QJ
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
IMPACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
_
.--'
FEE
GEN$Ra�"
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
-''
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING '
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
4 la-7 Ia
RECEIVED
DATE
/
�i
ti 1Z�, I6
/
ll
COMPLETED
2-9 /
9 Ab 9
INITIALS
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