HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONL
DATE FILED:
PLAN REVIEW F RECEIPT NO.: )% A55
PERMIT NUMBER: / (l
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE &,FILLED IN TO BE ACCEP ED
C`E L%
v10 St. Lucie County Building and Zoning �M
�,r �► . 2300 Virginia Avenue �Jl/
�OR10P Ft. Pierce, FL 34982-5652
772-462-1553
.- APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
�.o( X�,Z
1 LOCATION/SITE ADDRESS:.
__..--SITEPLAN-NAME:—
3. PROPERTY TAX ID Iy 33—/,zo—oo/y ^-&C-C� _ j—
4. LEGAL DESCRIPTION (attach extra sheets if necessary): _3 3 5'�ds�/ 5 7l, 51F!'OFi?i //y �U t+iDFUSJ
/9J/��Crl+2%<Sw Co/10F/v 3�5, g OfS /377, /F rOf— FK�
5. PLAT ' �(rPE ,?LO8. LOT
BOOK NO. NO. NO. Z4'
9. PARCEL SIZE: ACRES/SQ FT. y� C/ LOT DIMENSIONS L� X Ly
r
10. DESCRIPTION OF CONSTRUCTION PROD CT OR WORK ACTIVITY: �jT/�S%�A_1 _y15�
r1 �. Z hmen
H. SETBACKS (ACTUAL) FRONT: r ACK: 1 % RIGHT: LEFT:
1 SIDE SIDE
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
,K NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL (] INDUSTRIAL
L-4- OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION:_--[���_ 15. Sq. Ft. 1st Floor: 1 rOcJ�o .
16. VALUE OF CONSTRUCTION: $ Z ('
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 ntodifv 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 52500or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
NAME: &"le- Rom.%y co�� ��� Colony C-G-L MHP
ADDRESS: �i ., i / ,,_� •� / / Z_IJ(O t4- 678fite, Rd•-7
CITY: 6--* n4 L&dKhll1 STATE: ZIP 4 33513
PHONE (DAYTIME): 41K- 76?0a email: 17�1f�ii�H+i'�miro��jJn%�y a� •�
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OVA'NER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): �_ )
CONTRAC_TOR.INFORMATION---. .-_-r..._..._..
ST. of FL REG./CERT #: Z Y Ct9LL--, `l -7 / ST. LUCIE COUNTY CERT #: o`- l ?o-
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS: 5 0i
CITY: 2=E&r�ZZZ STATE: ZIP
PHONE (DAYTIME): 652VFAX NO. email:
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP -
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, -,,-
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 Niles), 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 1T 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,--
ATT.ACHMENT..T_-_
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/CONTRACTOR IGNATURE
STATE OF FLORI
COUNTY OF
�Tehe ffo�or''eengoi;1*1YA
ment
H_ril F ,
Type or Print Name of
Commission No.
by
identification.
ry' VALARIE SPELLS —�
FISSION # DD 5547, ..
€ EXPIRES: May 21 2oio
��i;' „ a 9trrtdad tBru t4a:ary Pabtc U:wanti7ilcf�
CONTRACTOR SIGNATURE
STATE OF FLO*.,
COUNTY OF
The -foregoing0� tAiment
- _-, -.7
, o is 1.personally
;p�gduced
UU'' as identification.
t NMMM19WOD 554758
EXPIRES: May 21, 2010
lQQ lodThruNotarypublicUndenAe-
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.
OFFICE.USE ON.-'-, BP #:. Q-7 11 a:�
N
SECTION
33
TOWNSHIP
2+S
RANGE
/10r
MAP NO.
ZONING
LAND USE
�
LOT CVG %
30��
TAZ NO.
FLOOD ZONE
FIRM MAP #
1�
1IT FLR ELV
MAX V?F
CONST TYPE
OCCUP TYPE
MAX OCCUP
/OF FLRS
WATER
�I
� I
SEINER
SPRINKLERS
STORMWATER
Lmu
LOT OF REC
LOT OF REC (after
11/90)
LOT SPLIT
LOT SPLIT
(before I/90)
REQU]
APPROVED
F ,!
v
`s 1
ADMINST
- _
LIBRARY -'A
PARKS'::.
'PERMIT: -
VARIANCE
_------ --- ______
IMPACT.FEE__
__. ,__..___.__..._IMPACTFEE__.
_,____,_____ __
FEE,- _.,._..__..
_._____._.___.
REPORT
CODE
Q
—1�,
PUBLIC BLD
IMPACTFEC-
;''
HABITABLE
AREA
RADON FEE
00
(RADON)
A�
'",
SCHOOL
IMPACT FEE
GROSS ROAD I
IMPACT FElf
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
I
DUE
SCHOOL
CRED
Qri
`Y
N
s ..::: r
}, r
{: ..k
TOTAL
IMPACT FEE
SCHOOL
<
IMPACT FEE
POLICE FEE
Fl
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL
Y
N
SPECIFY
TOTAL
PERMITS
of ALL
REQUIRED
FEES
REV WS
ZONING
ZONING,
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED, -BY
EXAMING
TE
//�.
COMPLETE
A-2 �`
INITIALS