HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE IJ .N , ,
DATE F
PLAN REVIEW FEE: CEIPT NO.: `'' — ` PERMIT NUMBER: ` 4/�
CONCURRENCY FEE: CEIPT NO.: CERT. CAP. NO.: 4444
ALL INFO MUST BE COMPLETE & FILLED IN TO BE A
J(.,1E CpG
N r St. Lucie County Building and Zoning
Fes;; 2300 Virginia Avenue
<OR10p Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: P-61 5t= V� cv�`Z
2. S/D NAME: �� 0 b M VIF SITE PL NAME: .
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 3,Y 3y yPIV .3 5-1 1z::'roF S 735; r9Fror-
5. PLAT 6. PAGE 7. BLOCK 8. LOT +�
BOOK NO. NO. NO. L+
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS �� Z
Noll. v5
10. DESCRIPTION OF CONSTRUCTION PROJECT R WORK ACTIVITY: „ .�1/.S/ LL.
� 1a
TIW AA
11. SETBACKS (ACTUAL) FRONT: BACK: l RIGHT: LEFT:
-� SIDE SIDE
TYP 12. F CONSTRUCTION (Check all appropriate boxes)
W CONSTRUCTION [ ] EXPANSION/ADDITION L ] INTERIOR RENOVATION
1RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: S�Z 15. Sq. Ft. 1st Floor: 7 J? Z
16. VALUE OF CONSTRUCTION: $ 1,00 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 (_.
n
NAME: b .)
ADDRESS: ` 1A 4 to X
r c8 � STATE: � � ZIP n�
CITY: +, i c{�'�' cN� in+ (yl i ►,_gr�t� •. G vrn
PHONE (DAYTIME): Cul y 7 email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAMEAND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
STATE: ZIP
PHONE (DAYTIME): (—)
CONTRACTOR INFORMATION
ST. of FL REG./CERT #:
�- l�C��%U � ST. LUCIE COUNTY CERT #: � � � �
o
BUSINESS NAME:
QUALIFIERS NAME: ^n
ADDRESS: !/S
V
CITY: i5iei2 Aj
C-1LG6 STATE:
154-
ZIP
PHONE (DAYTIME):
(-U7. % Cd (aV FAX NO.
2 `Fy Z/Zemail:
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
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
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.
OWNE CONTRACTOR�GGNATURF CONTR�CR�INA�IGP
STATE OF FL A l STATE OF FLOI- , N -�
COUNTY OF COUNTY OF ..•••===��JJJii11111
The foregoing i ument w owle ed The foregoing i Trument . ��jrnowle� y
s c./�' , 2��bY � this • j da o �/ 2D—/ ,'�Y
o is personally � � is personally
wn r a c
y w met o a A-6 as Identification.
( cation.
Signatur of otary Signa o ary
Print Name of Notary e or Print Name of Notary
Type or
e,, VAIAp (Seal)
Commissio �. S1IO�NW#D 554758 ,sue€ SION#DD554
�y € EXPIR06: May 21, 2010 pf� F aended rhrl rAN May 21 2010 758
7! ... �YP�bfic
Bonded 7hruWayPobHpbnd§rW6tora s IF APPLYING FOR
NOTE: T UIRED. EACH SIGNATURE M
THIS BUILING PERMIT AS AN OWNER/BUILDER; THE OWNER MUST PE RSO Y APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.
0 CE USE. ONLY:
SECTION
33
TOWNSHIP
34 S
RANGE
r
�-o C.
MAP N0.
.
ZONING
D u _
LAND USE
�M
LOT CVG %
/LO 2�
TAZ NO.
FLOOD ZONE
FIRM MAP #
',
15T FLR ELV
HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
G
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC (after
L
SPLI
LOT SPLIT
(before 1/90)
1/90)
QUIRE
APPROVED
,
ADMINST
LIBRARY A
PARKS A
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FEE
REPORT
CID-7
PUBLIC BLD
IMPACT FEE
HABITABLE
AREA
RADON FEE
CODE
Q)
(RADON)
SCHOOL
1%4^�,,1 1
`_�
GROSS R
CREDIT
Y
N
TOTAL ROAD
IMPACT FEE
IMPACT FEE
1V
IMPACT F
DUE
SCHOOL
CRE Q
Y
N
„':.
TOTAL
RAPACT FEE
SCHOOL
s�
IMPACT FEE
`ry\ J
POLICE FEE
F FEE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL
Y
N
SPECIFY.
TOTAL
PERMITS
of ALL
REQUIRED
FEES
t
1 .
REVIEW
ZONING
ZONING
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMING
DATE
CO ETE
TNTTTA T .4
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