HomeMy WebLinkAboutApplication for Zoning CompliancePA k AW
DATE FILED: /A 2 d
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER:
ALL INFO MUST BE COMPLETE 8t FILLED IN TO BE ACCEPTED
\E OOGy ST. LUCIE COUNTY PUBLIC WORKS g&4�pieNM
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
20R\OP FORT PIERCE, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
'f-!�19s7- owc �9j� C�;- �a)
PROJECT INFORMATION ZO r /� �lae/C3 0
P i pyre �G .
1. LOCATION/SITE ADDRESS:
2. SID NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary): J _
5. PLAT
BOOK
6. PAGE 5� 7. BLOCK
NO. NO.
— 8. LOT i
NO.
9. PARCEL SIZE: ACRES/SQ FT. 8Uo2 LOT DIMENSIONS //�s�',
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: �f/v�/ lf"Xe-
i
11. SETBACKS (ACTUAL) FRONT: BACK: ^ ® RIGHT
S FT
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[� NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ j INDUSTRIAL
14. Sq. Ft./CONSTRUCTION: U06L s�. 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: $ 00
The valve 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
indicateq 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
OWNER INFORMATION: /
NAME:
ADDRESS: UlO� .S7`
CITY: f �l�PT,s/-- -'^ STATE: 114�2- ZIP
PHONE (DAYTIME): C316l1
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.ICERT #:- ST. UCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): f I FAX NO.
ARCHITIENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP
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.
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, 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
j with all applicable laws regulating construction and zoning.
r
OWNER/CONTRACTOR STGNATURE
STATE OF FLO DAj ,,
COUNTY OF �^� _%
The foregoing instrumi
before ,rye, this 3 day
known to me or who
as identification.
�bbS- O
m
#
..,.1:� iS,':!. Gommission
,�rJotary�
Number
(seal)
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this _ day of , 20_, by
, who is personally known to me
or who has produced as identification.
Signature of Notary
Type of Print Name of Notary
Notary Public Title
(seal)
Commission Number
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.
BP M
SECTION:
(/
TOWNSHIP:
`�
RANGE:139
MAP NO.:
ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:/
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
MAX. OCCP:
# OF FLRS'
WATER:
SEWER:
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90).
LOT SPLIT
REQ'D -
LOT SPLIT
APPRV'D
_
DECAL
NUMBER
Y
IMPACT FEE
CT
(y..
PARKS
IMPACT FEE
1
06
PERMIT
REPORT
CODE
®o/MPACTE
PUBLIC
FG
/
REABALE
Aq
(RADON)
RADON FEE
O(_
b �r..yrA
Y MTOTAL
ROAD
GROSSROAD
CREDIT
ROAD
IMPACTZONE
�O
IMPACT FEE
IMPACT FEE
DUE
SCHOOL
�l
CREDIT
Y
N
a s
IMPACT FEE
pS,
TOTAL
SCHOOL
IMPACT FEE
POLICE FEE
FFH--��
I
D
FIRE FEE
MISC FEES:
TOTAL
�(/
POLICE/FIRE/
-
MISC. FEES
Y N
ADDITIONAL
SPECIFY.
Q7j.,O.C�`
PERMITS
TOTAL ALL
FEES
REQ'D
p v l
REVIEWS
ZcNING
ZONING
PLANS
PLANS
REVIEW D BY
VEGETATION
EXAMINING
SEA
DATE
COMPLETE
� n {y
Lam/,[` UX
' O p'1 , w,
TURTLE
INITIALS
w�y
T:)i,Ct JAI .
MANGROVE