HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
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 �it9
2300 Virginia Avenue
pI Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATI9N
n,_._ n.--j 7
l . LOCATION/SITE ADE
2. PROJECT NAME: tt
3. PROPERTY TAX ID #: }mil/'Is M /!tEAC 7LlJ
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
5. PLAT BOOK 6. PAGE NO.
PLAN NAME:
7. BLOCK NO. _/ 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.):� 1 LOT DIMENSIONS: 165 W : ., - la X � bJ�,5 v
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTNITY:
SETBACKS (ACTUAL) FRONTI r_.ft BACK: AAD_ RIGHT SIDE: LEFT SIDE: 44
TYPE OF CONSTRUCTION (Check all appropriate boxes)
1J
[1
NEW CONSTRUCTION
RESIDENTIAL
OTHER (SPECIFY) _
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
DESCRIPTION OF PROPOSED USE:
SQ. FT OF CONSTRUCTION: —;?n/-
5
16. VALUE OF CONSTRUCTION: $ LD 1 J
15. SF. FT 1st FLOOR:
1/
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 mom, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
V
NAME:_.LiPnni'� -Y �Prl'S2 �- >1S[c+�U
ADDRESS: ��- t c4 l
►
CITY: ao-y. S3,y!', STATE: I 23P:
PHONE (DAYTIME): (Ila aE 1'07(o& Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
ML IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER
ADDRESS:
CITY: STATE:
PHONE (DAYTIME): (_) ZIP:
CONTRACTOR INFORMATION
ST. Of FL REG.CERT #: s PC O s% 11 q ST.
BUSINESS NAME: _�4- S1 r, .1 C i- I..' I 1 �..
QUALIFIERS
ADDRESS:
COUNTY CERT #: l? �3591
f�
CITY: CmAn&r
STATE:
PHONE (DAYTIME): (� cR FAX NO.
ARCHITIENGINEER:
ADDRESS:
CITY:
(DAYTIME): (_ �
STATE:
ZIP --
BONDING
BONDING COMPANY:
ADDRESS:
CITY:
STATE:
ZIP:
MORTGAGE LENDER --
ADDRESS:
CITY:
STATE:
ZIP.
it w4 be voided and returned to you by issued d it is not picked up within � aNr noti5cati on
CERTIFICATION:
Thi§ 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
w@f(r will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
My be requited 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
with all applicable laws regulating construction and zoning
, ON SIGNATURE CONTRACT, SIGNA
STATE OF FLO� A�, STATE OF FLO A
COUNTY OF ' 1 4s" `� `—� COUNTY OF
The foregoing instrument was acknowledgedd� before r° 9 1 The foregoing instrument was acknowledged before
fife this day of (i X1 Q 20___I�, r o me this — L day of ���I, , ^ 20Q� , _J :R
�` o 3' 1'YX YFY 4.if 1 l r Z 8
by i n r; �^ n V (�A 9(1�lo��S 065
:A i: by _
W
Who is personally known or has produced 0 who is personally (mown Fy — or has produced a
r
_ as identification. z asidentif! Z Z
Signature of Notary 0N Signature of Not
Commission No ��3 (Seal) `C, sti!:t Commission No 3
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 OWNERIBUILDER APPLICANTS.
l+or specific instructions see appropriate permit checklist.
c
m
OFFICE USE ONLY BP #: -o
SECTION
ZS
TOWNSHIP
�I
RANGE
O�
MAP NO.
1.t7�V
ZONING
('1.�Ar�r"
LAND USE
��jM
`(�
LOT CVG%
TAZ NO.
FLOOD ZONE
FIRM MAP #
(Q•'
15T 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 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
�„aG�i}
AREA
FEE
FEE
//
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
IMPACT
-
IMPACTFEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
_
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENE
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 V GAS _
LOT OF RECORD
FEES
REQUIRED
PLUMBING _
FEES
DATE SENT TO ADDRESSING: ►�T /
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
i
INITIALS