HomeMy WebLinkAboutApplication for Zoning ComplianceOFFLCE US1 O1�iI Y:
DATE FILED: RECEIPT NO.: —
PLAN REVIEW FEE: RECEIPT NO-:
CONCtiRRENCY FEE:
ALL INFO MUST BE COMPLETE & FILLED IN 1 v
J�,�E CpG
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y� St. Lucie County Building and Zoning
� 2300 Virginia Avenue
• Fes.: Ft Pierce, FL 34982-5652
�OR10 M-462-1553
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• Jariii%�
BE ACCEPTED
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APPLICATION for .BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
'p"
1. LOCATIONISIIT�E� ADDRESS: �-
2. SID NAME: IQri ` b m SITE PLAN NAME:
3_ PROPERTY TAX ID #i:
- z o -Ov v- ocm
�✓ 3 y T EE of s /-2 35 EZ 26&i
4. LEGAL DESCRIPTION (attach extra sheets if necessary): SL r
71
o , &" Gr�2 d
6. PAGE 7. BLOCK 8. LOT —%
5. PLAT NO. �-L? NO. NO. �_
BOOK �k 7
9. PARCEL SIZE: ACRESISQ FT.y G 7 LOT DIIAENSIONS - 3 F X 7
7.
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WOI ACTIVITY:
11. SETBACKS (ACTUAL) FRONT 0 rt BACK: SIDE / �• �� SIDE / 5__ __7 if
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] RrmRIORRENOVATION
[ j RESIDENTIAL C ] COMMERCIAL [ ] INDUSTRIAL
[� OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. FtlCONSTRUCTION:
/"10 a 15. Sq. Ft. 1st Floor: / ,;L 0 0
16. VALUE OF CONSTRUCTION: $ �fy C;
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: �F �1 l�� l Co,'
ADDRESS: 0 ( N' / F ( ZIP 3 `f 9 4/ te
CITY: r� • QlG' (CP _ STATE:
ppliyy �%� 7iyOd1- email: `/JDUc�r PHONE (DAYTIME): (L9.-
IF THE FEE SRYTLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME*AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
STATE: ZIP
ST. of FL REGJCERT #: - H 8O d o S 7 % ST. LUCIE COUNTY CERT' #: 2 4/ `j z
BUSINESS NAME: _ Z9 Ag*4 -
QUALIFIERS NAME: f 22gi /I A17162
ADDRESS: 2,0b/ Gz:llvl-m "
CITY: i J AZ7QL66, STAVE: -E --- ZIP
PHONE (DAYTIME): ( )2- L/Z7Gd5 7 FAXNO. _5: T Z Z/7/Z,email:
ARCHIVENGINEER: SfCye- j..J DDT I
ADDRESS: , 9 So S►ti I �a n Ar
CITY: P S L STATE: ZIP
PHONE (DAYTIME): ??,21) 8 7sl" 7 3a A/
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.
I J �
CERTIFICATION:
This application is hereby made to obtain a Permit to do the work and installations as indicated, land to obtain a certificate of capacity,
T PP that no work or installation has commenced prior to the issuance of a permit and that all
if applicable, for the petted work. I certify FURNACES, BOILERS, HEATERS, TANKS,
work will be Performed to meet the standards of allG laws
WELLS,onstructiOn in OOLS,this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING,ennit application.
=1ND AIR CONDITIONERS, ETC., not otherwise included with this building p
permit applications are exempt from undergoing a full concurrency review: mom additions, accessory
The following building P PP screen rooms, utility substations & accessory uses to another non -
structures (all types), swimming Pools, fences, walls, signs,
residential use'. CE�.T MAY RESULT IN YOUR
OWNER: PAYING
TO RECORD A NOTICE OF sOT PROPERTY IF YOU INTEND TO
NOTICE TO OWN
PAYING TWICE FOR IMPROVE vfENT
OBTAING YOLIINR NOTICE OF COMMENCEMENT OR AN ATTORNEY BEFORE
RECO
NOTICE TO APPLICANT: AS THE AppLICANT FOR THIS BUI( DING PERMIT, NT; A CONDTITON OT YOUR RIO TMS LE
AND T T S SUBJECT TO ATTACHU E _
ATTACIMD
PERMIT LIEN LAW NOTICE GO TO THE PERN.SO WHOSE PROPERTY IS SUBJECT
CONSTRUCTION
TO ATTACFIMENT- - —�- - ---^— -
I certify that all the foregoing information is accurate and that all work will be done in compliance
OWNER'S AFFIDAVIT'
with. all applicable laws regulating construction and zoning.
CONTRACTOR GNATUl2E
OWNER/CONTRACTORSLGNATURE -
STATE OF FLORID
STATE OF FL&I,]RIRD COUNTY OF
COUNTY OF
The foregoing i ment w s acknowl ed
The foregoing ' trument w acknowled ed fore me day of 20Y
e day of 2&by , who ersonally
before m
A[Lnnn n �11 I. who i personally _tcnown toXie_ or AO AN pi0 -
Type or Print Name of Notary
Type or Print Name ov Notary
Commission No. (Sep)
Commission No. - --- (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACA SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS ANOWNERIBBICE UI O OWNER
OF MUST THE APP PERSONALLY
APPEAR TO SIGN
THIS APPLICATION IN THE
� LORIE AGERSTEMEIER
ICATION-
ropriate permit chec r;
Fo S ..•' C lI�>� ;,, MY COMMISSION # DO 514317
�; *= MY COMMISSION # OD 514317 - EXPIRES: February 14, 2010
s EXPIRES:February 14,2010 bC BardadrhruNotary Public Undervrtttera
,Rf,t •'
U " Bonded?hru Notary Pubtlo UnderwPltere
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VEGETATION
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REVIEWS
ZONING
REVIEWED BY
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