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HomeMy WebLinkAboutApplication for Zoning ComplianceOFFTCEUSE :QNL�: DATE FILED: PLAN REVIEW FEE: "IV RECEIPT NO:: �a� PERMIT NUMBER: CONCURRENCY FEE: o-0 , RECEIPT NO.: CERT. CAP. NO.: n n ALL INFO MUST BE COMPLETE & FILLED IN TO BE A JL16 C G .9• AS— 0&4-4'i f - IS ;+.:. St. Lucie County Building and Zoning t • 2300 Virginia Avenue • P Ft. Pierce, FL 34982-5652 lO RID 772-462-1553 APPLICATION for .BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: 117 1vy6 I FL- ��°+ fD A 2. S/D NAME: C o b SITE PLAN NAME: 3. PROPERTY TAX ID #: /02 C2 - ©cy o —00C.9 - 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 95% ! W�/ n,,, 5 7 s > 7.l- - C�F/7i� ti is w of v5 GCT T .3 7 F r� G rvoF v5I L/WP5 :7r c �r�o�r, �s�nnr r �-� rg3,��,�r7�• 5. PLAT 6. PAGE 7. BLOCK 8. LOT BOOK a$ g 7 NO. TA NO. N0. 9. PARCEL SIZE: ACRES/SQ FT. ��I Z LOT DIMENSIONS SI X 3 2 fJ . 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY:-LVS/704-[, M171 11. SETBACKS (ACTUAL) FRONT: O t ,/ "r BACK: / � � RIGHT: � �� it LEFT: 7 � � / SIDE l SIDE % 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL Qc] OTHER (SPECIFY)C �F USI 13. DESCRIPTION OF PROPOSED USE: 9 E s 14. Sq. Ft./CONSTRUCTION: 6 7Z (o 75 ''B-) 15. Sq. Ft. 1st Floor: 0 7 Z- to IF. 16. VALUE OF CONSTRUCTION: $ d� U 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 w C a 16 n y C. I - %� U / ft �•^ lT�a. ��/ co - ADDRESS: Di %V IA,S de CITY: { ' Q `�STATE: r-p 3 4 V f �D PHONE (DAYTIME): (KI email: �oa��r `J Go�o/1 Pet-id.b 4, NP• zoo 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): CONTRACTOR INFORMATION STATE: ST. of FL REG./CERT #: 0 02017 % ST. LUCIE COUNTY CERT #: 2,4Y ;I, BUSINESS NAME: QUALIFIERS .NAME: % C-5/1" ADDRESS: a sty A0 CITY: A-_77-64L E STATE: EL ZIP PHONE (DAYTIME): (?fL17 7 ('C4E2 FAX NO. email: ARCHIT/ENGINEER: io ADDRESS - CITY: r �� <� S'4-- PHONE (DAYTIME): (% %a� :i� ?1E�' + 7 3-,;k q BONDING COMPANY: AJIA ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: r ZIP STATE: STATE: ZIP 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: allations as indicated, and to obtain a certificate of capacity, This application is hereby made to obtain a permit to do the wo inrk stallation ati nhas commenced prior to the P ork or issuance of permit and that all if applicable, for the permitted work. I certify that no w work will be performed to meet the standards of all laws regulating construction in this RNA c nBOILERS, HEATERSate permits TANKS, may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACE permit application. AND AIR CONDITIONERS, ETC., not otherwise included with this building p PP tions, accessory The following building permit applications are wXallmpsi from underGreen goomsoing autil y substations & accessory usestoanother non - structures (all types), swimming Pools, fences, , g 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 FOIS THIS BUILDING PERMIT, � IT A CONDITION OF THIS�E AND INTEREST FAITH PERMIT YOU P ) IEN LAW NO ICE TO THE PERSON WHOSE PROTO DELIVER A COPY OF P THE IS SUBJECT CONSTRUCTIONATTACHED 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. 1—w �NER/CONTRACTOR SIGNATURE STATE OF FLORIDA STATE OF FLOC- COUNTY OF COUNTY OF ''• ;;; : z A � ` The foregoing in trument was a owledged _. W W The foregoing instrument was acknowledged o be re rn th g�day of , 20_ by 20� by y_ Riiyvho is personally b ore me this day ofi� v e, who is personally? own to me of ho has produced known to me r who has produced identification. as identification. I o = 9� ZC Q3o� 6 W Signature of N ary Signature o otary pOwnL Type or Print game of Notary Type or Print 14ame of Notary (Seal) Commission No. ______.— Commission No. (Seal) F APPLYING FOR NOTE: TWO (2) SIGNATURES ARE NOW EDBUILDERCH GTHE OWNNATURE ER MUST PERSONALLYUST BE IA PEAR TO SIGN THIS BUILING PERMIT AS AN OWN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION. For specific instructions see appropriate permit checklist.