HomeMy WebLinkAboutApplication for Zoning ComplianceDATE FILED:
PLAN REVIEW FEE: - D RECEIPT NO.: , PERMIT NUMBER: d L�5�^
CONCURRENCY FEE: •� RECEIPT NO.: CERT. CAP. NO.: 70q—xv
ALL INFO MUST BE COMPLETE. & FILLED IN TO BE ACCEPTEI
-� St. Lucie County Building and Zoning
n; 2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:
C $ 7 A/ S L E �Lr y
2. S/D NAME: /9 Io r)V C l 1b M-0 SITE PLAN NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 335ToFiLc'�y�yG-
�,t/o�tJS�An��,�c=(rAi SwG�Q nFni3�f Sf DFS 13��,iFi oj�v�t L ,an v v�/�v'ctY
iM s �� ,nI67ay itis, 1 ,i-rThAr.C5�V3FraOFPoQl WYn'
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK � NO. f g— NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. c% �% LOT DIMENSIONS y 5 X S•�
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:i�S/�f�G lJy�lQ i�
11. SETBACKS (ACTUAL) FRONT: /" "( BACK- / r I /f RIGHT: /i LEFT:
l / SIDE SIDE % 5
9
appropriate I
12. TYPE OF CONSTRUCTION (Check all pp p riate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [) COMMERCIAL [ ] INDUSTRIAL
[�] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: y 15. Sq. Ft. 1st Floor:
�3s�• 1,375, 7,6a
16. VALUE OF CONSTRUCTION: $ al
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
RECORDEDNotice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
,��. C�In►,y �14b ,SNP
NAME: �
rc e
ADDRESS: GU .
CITY: �� e rG� STATE: i ZIP
PHONE (DAYTIME): F-n) Z/78" email: 1— -6L,)
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED AB OVE, PLEASE
FILL IN NAME*AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
STATE:
ST. of FL REG./CERT #: .j y Deb V % / ST. LUCIE COUNTY CERT #:
BUSINESS NAME: �wti �v2VyGES
QUALIFIERS NAME:
'p
ADDRESS: ��� N���
CITY: �� %��-�= STATE: t L ZIP 3ySY� L
PHONE (DAYTIME): ( �%2% �On5 7 FAX NO. email:
�� ��7%a
ARCHIT/ENGINEER: -S / EV'C' CC,-C9 s®
ADDRESS:
CITY: ' , `.D� ��S% ,�J STATE: �1-- ZIP
PHONE (DAYTIME): (�17- $'� y
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. ,
A
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, 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, 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 construction and zoning.
OWNER/CONTRAC iRSIGN�ATUiE
STATE OF FLORID -
COUNTY OF
The foregoing instrument was acknowledged
l j
be ore me this,�t,2t day of mac, 20 y
AC who is
personally
to e or who has produced
ow?m_n
as identification.
¢mn
x
o fmn
Z
�...fn
Signature of N y
9
�o>v=
Type or Print ame of Notary
Commission No. (Seal)
CO TRACTOR S G ATURE
ip. -'NI
STATE OF FLOR
COUNTY OF
® i
X n a
;� � b 89 The foregoing in trument was acknowledged
before me this /day of P' ? 2%E, by
zz L ho is personally
own to me or ho has produced
rn v 'v
o C as identification.
,c �
Signature o otary
Type or P nt Name of Notary
Commission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THRAPPLICATION.
For specific instructions see appropriate permit checklist.
'R� 4
OFFICE USE .ONLY '
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
SEWER
SPRINKLERS
STORMWATER
WATER
LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT
(before 1190) 1/90) REQUIRED 777777= APPROVED
. .. ::-.. .. .: ... .. ...i. ,.•:. Ir;'•'' :I• •" Ci. :T...::�-'ta. �'i`�,,:'i �`.; rr�..;..., •:i•'r.-. t'-;`
... .. . .. :. •: i .... :,:1.� . • is : Np ti?i 1 i ..
<': �[.:' ;_i!i �:.a?fir'• ..
;: :arph:'ht•:.
ADMINST
LIBRARY
PARKS
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLD
HABITABLE
RADON FEE
CODE
IMPACT FEE
AREA
(RADON)
SCHOOL
GROSS ROAD
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
--------
IMPACT FEE. -
_ -
IMPACT FEE
-DUE,
SCHOOL
CREDIT
Y
N
TOTAL
SCHOOL
IMPACT FEE
,;
IMPACT FEE
POLICE FEE
FIRE FEE
MIS FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL Y N SPECIFY TOTAL
PERMITS of ALL
REQUIRED FEES
t ..I .
REVIEWS ZONING ZONING PLANS MISC. VEGETATION SEA TURTLE MANGROVE
REVIEWED BY EXAMING
DATE
COMPLETE
INITIALS