HomeMy WebLinkAboutApplication for Zoning ComplianceDATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NLTbIBER: i
CONCURRENCY FEE: i ri RECEIPT NO.: CERT. CAP. NO.:
1.
ALL INFO MUST BE COMPLETE u FILLED IN TO BE ACCEPTED
�0�6 OOGy ST. LUCIE COUNTY PUBLIC WORKS—
D BUILDING & ZONING DEPARTMENT \\\
2300 VIRGINIA AVENUE
'20p10P - - FORT PIERCE, FL 34982-5652
772462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATIONa`'r. 3 S9
LOCATION/SITE ADDRESS: _
2. S/D NAME:
R�
PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
R.E- �%O-iS
5_ PLAT_ 6. PAGE
BOOK NO.
E PLAN NAME:
7. BLOCK 8. LOT
NO. NO.5�
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS .3n --Y $®
10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:
11. SETBACKS/ACTUAL) FRONT: BACK: RIGHT ! / LEFT
/'N�
`. I / �: SIDE 1 •O SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
14.
Sq. FtJCONSTRUhTION:
r 3 i_I
15. Sq. Ft. 1 st Floor:
16.
VALUE OF CONS`jRUCT10N:
The value of construction is used to deterrdne 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 figuresare 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: /1 ^ /'
NAME: f7r/ PM4M A/ 9- �:1/�� / ^nPh /%n� .
ADDRESS: {/7( 'i�il.l /.-/ N-� /C/✓
CITY: ��i GAnnli�A STATE: D�/0 ZIP Al�
PHONE (DAYTIME): �3) '6 O- a O { n IS
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:
PHONE (DAYTIME):
STATE:
CONTRACTOR INFORMATION
ST. of FL REGICERT #: (-C� �d.7 ST. LUCIIEE COUNTY CE.R/Tn#:
BUSINESS NAME:
QUALIFIERS NAME: ,IEIA�,
ADDRESS: _ i��I ` - /�� iL
ZIP
CITY: 7f/��;�q/
/`7Il��J.
STATE:
ZIP
PHONE (DAYTIME): CM-)
_775 /
7
'Sot
FAX NO_
ARCHIT/ENGINEER: TWO&A5 n � OA2�
�ImG
ADDRESS: - 2 zzmaL(/�
40,
�y, v
CITY: - ��/[[7 �ij - STATE: ZIP 12963
PHONE (DAYTIME)[ ( 1.�. �c. % p2g• j I - ._ _
BONDING COMPANY: - - -
ADDRESS:
CITY: STATE: -
ZIP .
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 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 (ail 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 .
with all applicable taws regulating construction and zoning.
44 A-6�/
NER(CONTRA fOR SIGNATURE NTRACTO SIGNATURE
STATE OF FL RID STATE OF FLO IDA) nA
COUNTY 01 COUNTY OF Jc vW
The for oing itrument as acknowledged The foregoing m as ackn tedged
before a this I day of 20 by _ before a day ' 2OU by
who is personal) nown to me or who` is p onaily known to. me
has roduced as identification. or wffi has prod ed as identification.
Signature of Not
Type or Print Nam Pit
Notarvr PUbIiG Title
E'ommission Number
(seal)
commtw�n ' s ODi4 n ;'r
Of
Type of Print Name
Notary Public Title
Commission Number
(seal)
;AREN L LAVERAC
Public - State o1
CommWm N DD219883
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLYAPPEAR
TO SIGN. THIS APPLICATION IN THE OFFICE LISTED ON THEFRONT OF THIS APPLICATION.
BP #:
2iONING:
1
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD
ZONE:
//�j
FIRM IMP #:
1ST FLR ELV:
MAX HGT:
CST TYPE:
I
OCCP TYPE:
K
MAX. OCCP:
# OF FLRS:
(WATER:
SEWER:
SPRINKLERS
-
STORMWATE
R
LOT OF REC (befr 1m)
LOT OF RE C (aN 1/90)
LOT SPLIT
-.
LOT SPLIT
- -
RED'D -
APPRV'D
DECAL r
LIBRARY
-
PARKS
RMIT
UMBER
IMPACT FEE
-
tMPACT FEE
FEE
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( IMPACT FEE -
TABALE.
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TRADON FEE
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. I�loi h GROSS ROAD
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TOTAL ROAD
MPACT ZONE
�" IMPACT FEE
IMPACT FEE
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-
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ADDITIONAL SPECIFY: -
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PERMITS
FEES-
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REVIEWS - ZONING ZONING
PLANS
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