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HomeMy WebLinkAboutApplication for Zoning Compliancei4 OATF. FILED: ' ( -C)S �7k� C� PLAN REVIEW FEE: ,l 5u— RECEIPT NO.: a'� ( VtRMTI NUMBER: � 1 f ""MURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE FILLED IN TO BE ACCEPTED yJ�,\6 �OGy ST. LUCIE COUNTY PUBLIC WORKS ICI F �\ BUILDING & ZONING DEPARTMENT} 2300 VIRGINIA AVENUE '`<OR10o' FORT PIERCE, FL 34962-5652 772-462-1553 = APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION C� 1. LOCATION/SITE ADDRESS: -{ I!_rSr 2. S/D NAME: ©LbU&'l4 5mmISITE PLAN NAME: U 3. PROPERTY TAX ID 11: 4. LEGAL DESCRIPTION (attach extra sheets it necessary): 6, PLAT. 6. PAGE ) 7. BLOCK 8. LOT BOOK NO. ! 3 NO. NO. 9. PARCEL SIZE. ACRES/SQ FT. �j��-j(pa LOT DIMENSIONS /' 10. DESCRIPTION OF CONSTRUCIA PROJECTOR WORK ACTIVITY:�&w `�/V (✓CT�/t/ I, i 11. SETBACKS (ACTUAL) FRONT: BACK: f ID LEFT SIDE SIDE: IC 12. TYPE OF CONSTRUCTION (Check all appr ria a boxes)' to DQ NEW CONSTRUCTION [ ] EXPANSIONIADDITION [ ] ' INTERIOR RENOVATION fytr?t' RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) Q 13. DESCRIPTION OF PROPOSED USE 1 E5 (01 A) 7 Sq. Ft. 1 st Floor: — 14, Sq. Ft./CONSTRUCTION: (� �j 16. VALUE OF CONSTRUCTION: $ ` O I dig, modify the TPte value of construction is used to delermme.tho amount of permit fees to be assessed. SL Lucie County reserves the right to question andig, be is $2500 iWicated value of construction if itm is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the g x more, a RECORDED: Notice of Commencement must be submitted with this application. A SLCCDV Form No.: 001-02 3 r OWNER INFORMATION: NAME: ., ADDRESS: 190 CITY:,,��yy�� STATE: G ZIP PHONE (DAYTIME): IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL. IN HN, ME�AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: - - CITY: STATE: ZIP , PHONE (DAYTIME): I I .. CONTRACTOR INFORMATION ST. of FL REG.ICERT #• BUSINESS NAME:��/ QUALIFIERS NAME: iL i ADDRESS:. CITY: /ll� l'iSC PHONE (DAYTIME):S ARCHITIENGINEER: ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY: ST. LUCIE COUNTY CERT #. / 00 'v fMINIM STATE: JA FAX N4 62da5;o'l- ZIP / < / i�� / ZIP � i � - / ADDRESS: CITY: - STATE: ZIP MORTGAGE LENDER: 61"4:to ADDRESS: /� %� �� � Q.. ,, nI�C 67 A&-a6 � CITY: //(/evL�'TG&9 x"z STATE: �' W ZIP IMPORTANT NOTICE: When a permit is issued and it is not picked up within Q�j days after notification it will be voided and returned to you by mail. ClRT1FICA i-{®N: 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, f4rlho permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will bo performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits rriay be-reouired 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 (ali!ty0oVy+6wimming 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 cons on and zoning. OWNER/GON OR SIGNATURE CONTRACT S NATURE TT,iTE OF FLORIDA STATE OF FL IDA COUNTY 0. COUNTY OF The foregoing i owes acknow��dged The foregoing instrument was acknowledged +belorace t�Kersonall day of, 20[is, by _ fore me his day of , 20Q,L, by y know to me or who is personals known tome s. uc as identification. or who has roduce�j_� tJ 1as identification. Signature of Notary Signature of Notary . r? Type or Print Name of Notary Type of Print Name of Notary Not Public_ Title Notary Public Title AOA A Commilttiion Number ,)AM04149_ Commission Number �,M''♦ ,, Patrida missm (Seal). yq`�' PaMdsA CorMe (Seal) �/jrpl, Commission D0320440 'q es' es June 14. 2008 g My Commisslgr DD320448 ur w Expi `�a n Expires Jere 14, 2008 NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN QWNEkIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION 1N THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. BP OFF1�� tJS� ONLIt', �a SECTION: �� TOWNSHIP: 5/ _. RANGE: 7.fAP NO.: ZONING: LAND USE:: LOT CVG %: ^ 6I 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.(aftr1/90) LOT SPLIT LOT SPLIT REQ'D APPRV'D DECAL LIBRARY k ywrf� -de- PARKS ,: K '+ PERMIT NUMBER IMPACT FEE V C�l IMPACT FEE FEE35 REPORT PUBLIC BLDX �'�t�. hIABITABALE RADON FEE �Ju IM CODE IMPACT FEE c4 AREA ' �J (RADON) , N .. ROAD l Qom.P, GROSS ROAD CREDIT TOTAL ROAD '. IMPACT ZONE UPE CT FEE �p IMPACT FEE �® ��Oid SCHOOL CREDIT TOTAL IMPACTFEE SCHOOL s - IMPACT FEE R9NfrE FEE FIRE FEE : MISC FEES: TOTAL pro POLICE/FIRE/ MISC. FEES IN .ADDITIONAL SPECIFY: �I/Ve4l$l rJ5 '. TOTAL ALL PERMITS HV/4"c— FEES REQ'D REVIEWS ZONING ZONING PLANS VEGETATION SEA MANGROVE . REVIEWED BY EXAMINING TURTLE DATE COMPLETE INITIALS''�---