HomeMy WebLinkAboutApplication of Zoning ComplianceDATE FILED: ! ZL n
PLAN REVIEW FEE: SO RECEIPT NO.: PERMIT NUMBER: Q(10 I � 015 6
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE U FILLED IN TO BE ACCEPTED
ST_ LUCIE COUNTY PUBLIC WORKS PE: Pei r-6. , }
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE Ot-001 - 01rj�j
`jORIDP FORT PIERCE, FL 349825652
772-462-1553
APPLICATION for BUQ-,DING PERMIT
CERTIFICATE Of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: OJO 1 1` wwtl6d Kco
2. SID NAME: SITE PLAN NAME:
3. PROPERTY TAX ID #i 1501 %os " O 3 iq, —lCo —
4. LEGAL DESCRIPTION (attach extra sheets if necessarvl
ti.- PAGE 7_ BLOCK
BOOK NO_ 5 3 8_ LOT.
NO. 26
NO-
9. PARCEL SIZE: ACRES/SQ FT. . Z3 ac ' LOT DIMENSIONS JI ' x 15 t
10_ DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
SWIMMING "POOL & DECK t�
11_ SETBACKS (ACTUAL) FRONT: BACK:
RIGHT 1 p� LEFT
SIDE eC� SIDE/
12= TYPE OF CONSTRUCTION (Check all appropriate boxes)
(7SjIX NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[) RESIDENTIAL [ ] COMMERCIAL [ ] INTERIOR RENOVATION
[ ] OTHER(SPECIFY) . I) INDUSTRIAL
13. DESCRIPTION OF PROPOSED USE: RESIDENTIAL
14. Sq. FtJCONSTRUCTION: �pqQ -�
15. Sq. FL 1st Floor.
16. VALUE OF CONSTRUCTION: $_20; 000
The value of conduction is used to determine the a - -
indicated value of - mount of permit fees to be assessed. SL Lucie County reserves the right to question and/or modify I
or more, a �tru�ocr d it is demonstrated that the a bmitted submitted
wietsh are not coilsislont with similar types of construction activities. If the value is $2f
RECORDF_p Notice of Commencement must be suDmRted witFr this apptigGon_ -
3LCCDV Form No.: 001-02
OWNER INFORMATION: 'sy��
NAME: p�I 1 Go rdo
ADDRESS: U�O� ��p A}Tj'r 1?I
CITY:
STATE: EL ZIP 3 T `( 5 I
PHONE (DAYTIME): _( I
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:
LP
CONTRACTOR INFORMATION
ST. of FL REGICERT#: CPC 0572()0. ST_ LUCIE COUNTY CERT #: 19104
BUSINESS NAME: A & G CONCRETE POOLS, INC
QUALIFIERS NAME: ARTHUR ALLEN _
ADDRESS: 410 SAEGER AVRMnF
CITY: FORT PIERCE - STATE: FT -
zip 34982
PHONE (DAYTIME): _(-77D 8�1Z52 FAX NO_ 467_162.
ARCHITIENGINEER:
ADDRESS: OLD "DIXIE HIGHWAY
CITY: VERO BEACH _. STATE: FL
zip 32962
PHONE (DAYTIME):
BONDING .COMPANY: - -
ADDRESS',:,.:.. -
CITY: -..
_.. .. .. STATE_ ZIP.
MORTGAGE LENDER: -" - - - - -
ADDRESS: .
CITY:
STATE: Zip
IMPORTANT NOTYCE'When a•permit is issued and it is not
after notifcafion 'it will be voided and returned.to you by ma),cked up within 60_ days
II
s
CERTIFICATION:
Thisapplication 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 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, ANDAIR 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, residential use. utility Substations &:accessory uses to another non -
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING`
TWICE FOR IMPROVEMENTSTO 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.
NER/_
OWC N O T RAC TOR SIGNATURE CONTRACTOR SIGNATURE
I
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The foregoing iry�lrument was acknowledged The foregoing 1 strument was acknowledged
before me this . day of /�, 20_0G by W e(_,JV before me this ( day of =kZw_>n
O C, by
who is,ppersonally know e or wha A2TkCP ✓fl (& w ho i rsonme.-
ha produced yClu . (( �a tcation. or who has roduced
fication.
Signa ure of Notary ignatuee of Notary
Type or Print Name of Notary, Type of Print Name of Notary,.
Notary Public Title Notary Public Title
^^ ""646Commission Number �— n�1u k�STEPHENA. VdU "K
y siEpHENA.WUyCHECK QQr § ,CornmjssionNumber AOVIN'_ 69@
00
MYCOMMISSION#DD457696 +t \. MYCOMMISSION#D
(Seal) EXPIRES: AUG 02, 245 (sea].EXPIRES; AUG 02,
) "`� Bonded throuip Ist State InTuranu
°` SondeC through lst State Insurance
-.:
NOTE: Tyyp (2)SIGNATURES ARE REQUIRED_ EACH SIGNATURE MUST BE NOTARIZED.
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST_ PERSONALLYAPPffAR--
TO SIGhk THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
::. ,
SECTION:
02- -
TOWNSHIP. -
A-�
RANGE:
�(.�
MAP NO.t
I d Z
ZOPIING
LAND USE:
P L
LOT CVG %: _
TAZ NO._.
FLOOD ZONE
FIRM MAP #:
1ST FLR ELV:
MAX HGT:
CSTTYPE
OCCP TYPE-
MAX. OCCP:
# OFFLRS:
WATER:.
.-
SEWER:
SPRINKLERS
-
-STORMWATE
R
LOT OF REC (Ge$/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REQ'D
-
APPRV'D
E
DECAL
LIBRARY
PARKS
PERMIT
-NUMBER
IMPACT FEE ,
IMPACT FEE
FEE
REPORT
- PUBLIC BLDG
HABITA ALE
RADON FEE
CODE
,.��
IMPACT FEE
AREA
(RADON)_
ROAD
IMPACT ZONE
GROSS ROAD
CREDIT
Y N
TOTAL ROAD
IMPACT FEE
IMPACT FEE
DUE
"SCHOOL ,...
. IMPACT FEE
`
CRED F
, .
Y .
. N
--� - -
'
- - -
TOTAL
..
._ SCHOOL
- -
_
IMPACT FEE -
- -
POLICE FEE
FIRE FEE
. "
MISC FEES:
TOTAL
j
-
POUCEIFIREI
-
-"
MISC, FEES
-ADDTTIONAL
SPECIFY:
" PERMITS
TOTAL ALL -
REQ'D
FEES
REVIEWS"
ZONING
ZONING -
PLANS
-VEGETATION
SEA
REVIEWED BY
EXAMINING
TURTLE
MANGROVE
DATE
COMPLETE
J �" T '
; ✓ /liQ
INITIALS
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