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HomeMy WebLinkAboutApplication for Zoning ComplianceM 'OFFICE USE_ONLY ¢� PLAN REVIEW FE) / vim! RECEIPT NO.: CONCURRENCY FEE: o'"� S[7c� RECEIPT NO.: G PERMIT NUMBER: nSi I o CERT. CAP. NO.: \ ALL INFO MIDST BE COMPLETE & FILLED IN TO BE ACCEPTED �L\E CpGy D a h St. Lucie County Building and Zoning 1 2300 Virginia Avenue Pie •'c�ORIOp'- Ft. Pierce, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: 1A5 ` ( i 2. PROJECT NAME: SITE PLAN NAME: o o 3. PROPERTY TAX ID #: 1 y 3 3 oZ t7 ) w b 6 0 0 5- 4. LEGAL DESCRIPTION (attach extra sh is if necessary):. 3 3 3 q �/�% /V 3S8° O— S 173S. 9 6'F NC %l I- Y6- W G1S- / a 07 Aeu -, - sAl 6o � o-F3 6-5 -r -f e� S 13 � 7 F� off 5. PLAT BOOK -2&r-? 7 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): , A(_7 �r'e LOT DIMENSIONS: � `� OD 'A oS o I �10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: t4 S eJ m o bf le A,,ti e In S4-A 1( SETBACKS (ACTUAL) FRONT: 1 BACK: �2- f $ RIGHT SIDE: 0 LEFT SIDE: / TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [I INTERIOR RENOVATION [ ] RESIDENTIAL ] CO RCIAL [ ] INDUSTRIAL [L]THER (SPECIFY) CA54 (RA obi a ��t oyl'l DESCRIPTION OF PROPOSED USE: SI SQ. FT OF CONSTRUCTION: g(9 9 VALUE OF CONSTRUCTION: $ Aao D 0 15. SF. FT 1 st FLOOR: 8 6 y 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 r OWNER INFORMATION NAME: f , v\ rid,, core GQ hA . C a 1 o n y c. v� � (1 i � 1 ADDRESS: a`�% 01 1" . US I r CITY: STATE: 1� t 21P. PHONE (DAYTIME): (� Li g 7 (Ry Email: Ii1 D L•1 �ia C-o� t��.� c.I t•� vv� �i (J• ©�^ 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: STATE: ZIP: PHONE (DAYTIlVIE): L—) CONTRACTOR INFORMATION ST. of FL REG.CERT #: �II ST. LUCIE COUNTY CERT #: �Y BUSINESS NAME: a.00 <1 6J( Toy h4 QUALIFIERS NAME: ADDRESS: 21 - I S LJ T, �P D tL //, CITY: Via J /tom C o"�'� STATE: ZIP: 3 9 D PHONE (DAYTIME): (M Z lS 31r3U FAX NO.p1Y LS, 477/0� Email: ARCHIT/ENGINEER: 4e- V e 0 O DS P, ADDRESS: Q S O �'�+� �► 17 u;, CITY: ®S L STATE: F f ZIP: +' PHONE (DAYTnvIE): L?7a) 97 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, FENCES, ETC., not otherwise included with this building permit application. St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. 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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. OWNER OR CONTRACTOR SIGNATURE CCWTRACtOR SIGNATURE STATE OFTL STATE OF FLORID COUNTY OFLjd��COUNTY OF The foregoing instrument was acknowledged before me this 0 4 day of 20 by who is pe�sonally known __�_ or has produced The foregoing me this a q by who is aersbn ument was acknowledged before of 20 n a a known or has produced as identification. deg i Si tore � Signa a of ota y MY HIE A. GERS EFa Commission No ��Lo MMISSlO��S y43 Co (Seal) 'Rtk�' 9ohdadlhrya AFYP�blryUnd® a 14p�a NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MU: THIS BUILDING PERMIT AS AN OWNERIBUILDER, THE OWNER THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF'. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OW For specific instructions see appropriate permit checklist. 1 1 YING FOR P. TO SIGN OFFICE USE ONLY BP #: & 8 SECTION 3 3 TOWNSHIP 3� � RANGE � i� `� MAP NO. ZONING LAND USE LOT CVG % cJ p II� 1� TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT ! CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS ' WATER EWER SPRINKLERS STORMWATER LOT OF REC Before 1/1990 LOT OF REC After 1/1990 LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT CODE Gi ® t� 11 HABITABLE AREA (RADON) RADON FEE PERMIT FEE / LIBRARY IMPACT FEE PUBLIC BLD IMPACT FEE CORRECTION PUBIC BLD IMPACT FEE G i I PARKS IMPACT FEE SCHOOL IMPACT FEE ROAD IMPACT FEE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT FEE -lnt�WAY REQUIRED Y N DRIVEWAY FEE i ADMINISTRATIVE VARIANCE FEE SPECIFY SUBS REQUIRED MECHANIC ROOF ELECTRIC GAS PLUMBING NON -CONFORMING LOT OF RECORD FEES MISCELLANEOUS FEES' DATE SENT TO ADDRESSING: 1 REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW RECEIVED C !D a7 D (i • . v DATE COMPLETED f ° OL • O,s •O INITIALS