HomeMy WebLinkAboutApplication for Zoning ComplianceDATE FILED: t 1�IOa,O
PLAN REVIEW FEE: ai .00 RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.: -
ALL INFO MUST BE COMPLETE & FILLED IN TO: BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1 ; LOCATION/SITE ADDRESS: 1'3 10 O (,.1 A O t\I C J V4 55t� I C. A iJ (`
2. PROJECT NAME: SITE PLAN NAME: C 1'r 1. b 4 C00
3. PROPERTY TAX ID #:. 'J 7,11- % 01 — UC26
4.<.:,,... LEGAL DESCRIPTION (attach extra sheets ifnecessary):
5. J PLAT`BOOK 6. PAGE NO. Z,9 7. BLOCK NO. 8. LOT NO. �-
9. PARCEI, SIZE (ACRES/SQ FT,): JF- . Z . LOT DIMENSIONS: q 1 L
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: — B&I 1ZCz Vim►
11. ; SETBACKS (ACTUAL) FRONT: 100 BACK:. c395 . i RIGHT SIDE: ` 154 LEFT SIDE: i
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ .] INTERIOR RENOVATION
RESIDENTIAL [ ]. COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
.13. DESCRIPTION OF`PROPOSED USE:: �(; `J tTJ cN ► ��
14. SQ. FT OF CONSTRUCTION: M % `1 15.E SF. FT 1st FLOOR:
16. VAUE _OF CONSTRUCTION: $ ZZ i
The value of construction isused 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 constructiaq,if it is deteonstratcd that tho.submittod figures are not consistent with similat-types of construction aotivitios. If the valuo;is $2500 or more, a
RECORDED.NoticcofCon mcnbcmcnt'mustbe submitted with this application ;
SLCCDV Form No 001-02 ,
t ' UPDATED 6/25/09
OWNER INFORMATION
NAME:
ADDRE
CITY: _iOC7'EX' LockG STATE: -,F ko�A)b f\ ZIP: .5 4 1-M (C.
PHONE (DAYTIME): d9b 83 88 98 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: STATE: ZIP:
PHONE (DAYTIME)6,
CONTRACTOR INFORMATION
ST. of FL REG.CERT.,#: CF-C 1) 71 ST. LUCIE COUNTY CERT #: 'Loci 7-
BUSINESS NAME:
-QUALIFIERS NAME.
ADDRESS
ZIP
CITY: STATE:
Email: q1 Ps 1,-V CA k
PHONE (DAYTIME):-, FAX NO.
cz�s L'� C- k
ARCIRT/ENGINEM
ADDRESS:
CITY:
PHONE (DAYTIME): j" 09
W
BONDING COMPANY, -"'-
ADDRESS:
STATE: T-, � C, %?- i t-b 04% ZIP: 3499 7
CITY: STATE: ZIP:
Y MORTGAGE LENDER. XJS -i
3>'.
ADDRESS:
CITY: o STATE: ZIP:
IMPORTANT NOTICE: When 'j?dC'mit is issued and it is not picked up within 60 days: after, notification
it WM be voided and returned -io-'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, BEATERS, 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.
0,01MIfiRACTORS1,GNATURE
STATE OF FLORID �`
COUNTY OF
The foregoing instrument was acknowledged before
me this day of �f 20_�L
who is personally knowp_, or has produced
identification.
..b..__..._--.--_-, t�Rr►u� BARBRAAMODMAN
Commission No. # COMMISSION i FF 101341
PIRES: March 12, 2018
Jr1�ORlb ' BOAdId*v8W,petNcWryServI=
CONTRACTOR SIG ATURE
STATE OF
COUNTY OF ,
The foregoing instrument was acknowledged before
me this day of 20
by
who is personally knowv—\—Or has produced
as identification.
Signature of , otary
Commission No. `� Y CO MISSION f FF 101341'
.�; � rRA GOODMAN
A
* O* EXPIRES: March 12, 2018
i0reat 8ondedihruBudgetNotaryServices
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.
a a a a
For specific instructions see ap#ropriate permit -checklist. }
i
OFFICE USE ONLY BP', mol - 0
SECTION
i
TOWNSHIP
!J
RANGE
MAP NO.
�� I
ZONING
O
LAND USE
1�
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
16r FLR ELV
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 111990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
(RADON)
'LIBRARY
PUBLIC BID
PUBIC BLD
PARKS
.IMPACT
IMPACT FEE
IMPACT
IMPACT
?RE.
CORRECTION
FEE
FEE
GENERAL
.'SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
`IMPACT
IMPACT
IMPACT
FEE
Fes.
FEE
FIREIEMS
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
RECEIVED
.DATE
COMPLETED
INITIALS
e
i i 1 I i i