HomeMy WebLinkAboutApplication for Zoning Compliancer, :1
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OFk'ICE�US�O�TI%?�:
DATE FILED:--.- RECEIPT NO.:
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE:
I.
2.
3_
4.
5.
9.
10.
11.
12.
13.
PERNIIT NUMBER:
CERT. CAP. NO.: -
ALL XNFO MUST SE COMPLETE & F1LLEV ltv .t,W
J � BOG
��< St. Lucie County Building and Zoning
V'� , 2300 Virginia Avenue
FL Pierce: FL 34982-5652
<OR10 772-462-1553
BE A
APPLICATION for .BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
-9 In Y / /(-/ 0 CJ V / � � � `y
LOCATION/SITE ADDRESS:
S/D NAME: C 1 b SnE PLAN NAME:
PROPERTY TAX ID #: y 3 — D� — �y S
3 3 3 K '10 NI 3Sa"� � F-i
LEGAL DESCRIPTION (attach extra sheets ij necessary):
.IC 4I LyU LJ !f 14S-1 0-#' be of Sw Loy d f N [pS: oF'
OT 7. BLOCK 8. LOT
PLAT 1 �.�.L 6. PAGE NO NO.
BOOK �� NO.�
D D LOT DIMENSIONS %
PARCEL. SIZE: ACRES/SQ FT. , c �
r t�.cemen"�" e
DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: " Gt S ✓� D
N
0,A
SETBACKS (ACTUAL) FRONT: ! I ,BACK: rt SIDERIGHT:% S 3 SIDE / 7
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL CO CIAL [ l INDUSTRIAL
[ OTHER (SPECIFY) ._l^ b j rYt 061 le
DESCRIPTION OF PROPOSED USE: S G
14. Sq. FL/CONSTRUCTION: 044 9 W �,V I 15. Sq. Ft. 1st Floor: 1QQ //JJ
l((�W•q�
16. VALUE OF CONSTRUCTION: $ "ko 0 a
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
OWNER INFORMATION
NAME: A ✓► G'
I��P.A or
ADDRESS:
re e STATE:
CITY:. P f P
zip
PHONE (DAYTIlb1E): (is� y�X 7� D� email: �I
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE C
FILL IN NAME'AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTMEM): (—)
_ 3 Q' LP
'nIDnXC-I-bIYl1�� Com
VNER LISTED ABOVE, PLEASE
CONTRACTOR INFORMATION
ST. of FL REGJCERT # FI O D D a 6 7 ST.. LUCIE COUNTY CERi C oZ ti pa y
BUSINESS NAME: f3r0 of n Mo
QUALIFIERS NAME: / 0 /Y1 4n' app G'
ADDRESS: S'01 Ceh 4er i�`� • {
CITY: Pt.
( (ce STAVE: / zip -3Y9 YU
PHONE (DAYTIME): oZ 7 UOY % FAX NO. 'SY,27.Sa Ay wa ennail: `I vta.,-,S z co I onyc. l a b m
ARCHITIENGINEER S V e
ADDRESS:
7S6
CITY: P,5L
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
STATE: F ► ZIP
STATE _ ZIP
MORTGAGE LENDER: j
ADDRESS: ZIP
CITY: STATE:
I
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 daws after notification
it will be voided and returned to you by mail.
i
CERTIFICATION:
his application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of Capacity -
This pp er y ma work I certify that no work or installation has commenced prior; to the issuance of a permit and that all
if applicable, for the plawsreguconstruction in this Jurisdiction. I understand that separate permits.
performed to meet the standards of TANG, SIGNS, L S, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
work will be p pI,UMB t application.
may be required for ELECTRICAL,
r�ND AIR CONDITIONERS, ETC., not otherwise included with this building
pp
a lications are exempt from undergoing .a full concuireney review: room additions, accessory
The following building permit pp walls, signs, screen rooms, utility substations &accessory uses to another non -
structures (all types), swimming pools, fences,
residential use- MMENT MAY RESULT IN YOUR
FAILURE TO CORD A NOTICE OF SO �pp�.� � YOU INTEND TO
NOTICE TO OWNER: .
PAYING TWICE FOR IMPROVEMENT
OBTAIN G�O� NOTICE OF COMMENCEMENT LENDER OR AN ATTORNEY BEFORE
RECORDING
NOTICE TO APPLICANT: AS THE APPLIC TAHATOIS SUBJECTT�INTTA NT- AS A CONDIG PERMlT,1F IT ISTION OFTHIS
NOT YOUR RIGHT, LB
AND
PERMIT YOU
fi N LIEN LAW NOTICE TO THE ERSC- WHOSE PROPERTY S SUBJECT
CONSTR
TO ATTACHMENT -
the -------===
AFFIDAVIT: I Certify that all foregoing informan otiniiction and zoninand g at all work will be done incompliance
OWNERS is accurate
.x„th all applicable. laws regulating
�- CTOR SIGNATURE
owNExiCONTRA
STATE OF FL
COUNTY OF
The foregoing i;stfnmerit
— th;c Lo�av of
who
known to me or who
Type or print Name of Notary
Commission No. (Seal)
CONTRACTOR SI NATURE
STATE OF FLORID '
COUNTY OF
ed
The foregoing ir�ment ackn ]g g
before me 's ay of2 by
�personally
imown to me or who has produ
,.. as identification.
Signature
Type or Print Name of Notary
No, ._ _._--(Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRE• EACA SIGNATURE MUSTBE NOTARIZED. IF APPLYING FOR
THIS BUILING PE M TX S oak OW ERRIBLISTLDNER`I"I E FRONT OF THE APPMUST LICATION.- APPEAR TO SIGN
THIS APPLICATIO
For specific instructions
�oE�� ��g1A3i7
My Og S F, 0%a! ae�rr+10 95
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permit checklist•
„ y LORIE A. OERSTEMEIER �•,
,iti� eY 14317 `a
MY COMMISSION # DD 5 `
EXPIRES; February 14, 2010
g ` a dedThruNoteryPubli �
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ovvicF, USE ONLY
NO.
SECTION
TOWNSHIP
c3q
RANGE
ZONING
LAND USE
LOT CVG %
j h
TAZNO.
FIRM MAP #
1ST
FLR ELV
MAX HGT
FLOOD ZONE
07
-
MAX OCCUP
# OF FLRS
CONST TYPE
occup TYPE
-------
SPRINKLERS
STORMWATER
SEWER
WATER
------
LOT OF REC (after
LOT SPLIT
LOT SPLIT
APPROVED
LOT OF REC
190).,
RE UIRED
(before 1190)
PARKS
PERMIT
ADmINST
LIBRARY
IMPACT FEE
IMPACTFEE
FbE
VARIANCE
PUBLIC BID
HABITABLE
RADON
REPORT
IMPACT
AREA
CODE
9DI
I
(RADON)
_LA�
CREDIT
N
TOTAL ROAD
SCHOOL
GROSS ROAD
IMPACT FEE
RaACTFEE
IMPACTFEE
SCHOOL
CREDIT
,N
rcw I
TOTAL
SCHOOL
IMPACT FEE
IMPACTFEE
POLICE FEE
FIRE
DaSC FEE
TOTAL
POLICE/FIRE
14/9�L) I
55
MISC FEES
TOTAL
ADDITION
N
SPECIFY
S
of ALL
p
FEES
IRED
ti
ZONING
MISC
VEGETATION
SEA TURTLE
MANGROVE
REVIEWS
ZONING
RExnpwTzn BY
EXAMING
DATE