HomeMy WebLinkAboutApplication for Zoning Compliance4) ,
OFFICE�USE ONLY:,r 11
DATE FILED V r' (n
PLAN REVIEW FEE: RECEIPT NO.: v" �� PERMIT NUMBER: I — D "'
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300Pierce,
FVirginia4982- 6 Ob
Ft. Pierce, FL 34982-5652772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
T
PROJECT
1 ^INFORMATION -
1. LOCATION/SITE ADDRESS: v'Ut c� 1Ol�.� QW9 .J e rl5e n � •c 4. e h 344957
�
2. PROJECT NAME:441ge-Alexg SITE PLAN NAME: 2��Jp 1 e,Pr�I
3. PROPERTY TAX ID 4:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
it
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: cp
10. COMPLETE DESC PTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
ia► i" S
11. SETBACKS (ACTUAL) F ONT: 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. DESCRIPTION OF PROPOSED USE: �� n
14. SQ. FT OF CONSTRUCTION: f 15. SF. FT 1st FLOOR: 01ce--
16. VALUE 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
I,J1�VJ
UPDATED 6/25/09
OWNER INFORMATION
NAME: // S�- (/!"n UXf'
ADDRESS:
CITY: /V. A&Z Nwy-�STATE: ZIP: �✓�7��
PHONE (DAYTIME): ( �tl' 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: /{//9
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): �)
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CONTRACTOR INFORMATION
ST. of FL REG.CERT #: L
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
I1%
ADDRESS:,2 �QD� yS lX�lf
CITY: lu"4- IT 4", .0 JIA;j— STATE:
PHONE (DAYTIME): &a6 li - 00 FAX NO.
ARCHIT/ENGINEER:
ADDRESS: 41oR / v
V GlltJ6n
CITY:
PHONE (DAYTIME):
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BONDING COMPANY: /✓ /�
ADDRESS:
CITY:
ST. LUCIE COUNTY CERT #:
ZIP:
rg"W;'
STATE: ZIP:
MORTGAGE LENDER:
ADDRESS:
i
CITY: STATE: ZIP:
IMPORTANT NOTICE: When a ermit 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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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 forany restrictions which may apply.
The following building permit applications are exempt fiom 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.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLORID COUNTY OF � Y�Al
The foregoing instrument was acknowledged before
me this o day of 20 A/ ,
by.Z42
who is personally knownN or has produced
identification.
CONTRACTOR SIGNATURE
STATE OF FLORIDA�/
COUNTY OF Jl7.�ll�.
The foregoing instrument was acknowledged before
me this day of 20 / ,
by
who is personally knowny or has produced
as identification.
�,�L-&7 04 00o
Signature of Notark
PRANCES DONZA Signature of Notary , ti; Y'P�; FRANCE$ DONZA
,, : *= MY COMMISSION # FF 014070
x^'C MISSION # FF014070 ,<-( �(PIRES; July 27, 2017
Commission N '*: 0 IRES: Jul 27 2017 Commission N '• °= HH
Public Undenvdters ,,,flf �?a• o Thru Notary Public UndarwrK�
Bonded Thru Notary '
i
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.
1a r
OFFICE USE ONLY BP #: Pz _ 04
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
I
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP # ''
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
I
MAX OCCUP
# OF FLRS
WATER
l
SEWER
j
► /
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
CODE
I�(
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
(RADON)
LIBRARY
PUBLIC BID
IC BLD
PARKS
IMPACT
IMPACT FEE
PACT
IMPACT
FEE
CORRECTION
PEE
FEE
GENERAL
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:
i
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
CO ER
REVIEW
VIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
'
RECEIVED
t iq
DATE
COMPLETED
INITIALS
'I/