HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY:
DATE FILED: jO3
PLAN REVIEW FEE: �� RECEIPTNO.:1 PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: -0001
ALL INFO UST BE COMPLETE & FILLED IN TO BE ACCEPTED
JL1E G ,.
St. Lucie County Building and Zoning
c1�►, 2300 Virginia Avenue
�OR1�P Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
I.--•-•LOCATION/SITE-ADDR ��� .
2 �_ S/D_NAME:- G �4 IVI j�—SITE PLAN -NAME. - -----
3. PROPERTY'TAX ID #:v ��%� 3 - /gip �(��!y ^ 00 --S
4. LEGAL DESCRIPTION (attach extra sheets if necessary) -'a_
� � All-° 3b5,8 +o �A -1!,� S L W4 �49 FO I-A5 �z 1-, j
5. ��bI
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT.";2-� G
o
LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:W
1 1. SETBACKS (ACTUAL) FRONT: `p BACK: i/ RIGHT: --+ LEFT:
,-SIDE —1 SIDE l
7-3 252g
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)'
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
164- RESIDENTIAL [ ] COMMERCIAL .k- [ ] INDUSTRIAL
J OTHER (SPECIFY) I
13. DESCRIPTION OF PROPOSED USE:
i
14. Sq. Ft./CONSTRUCTION:�O D 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: S _ . �00
I
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 a&vities. if the value is S250i)Dr more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
NAME: F-1-pic gee'14
ADDRESS: 1 2 ,
CITY: - ,,' ',� �Wy1i I STATE: ZIP 4I'R"
PHONE (DAYTIME): �1� �i! 8 ?�0 email: ���rvtiame M,� sser , -?j •Cam,
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY ONVNER) 1S DIFFERENT FROM THE O'ArNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): L_)
ARCHIT/ENGINEER:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTIME): (_)
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP _ .
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: ZIP
IMPORTANT \'OTICE: «'hen a permit is isstied 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. l certify that no work or installation has commenced prior to the issuance of a permit and that a]I
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,-
TQATTACHMENT:
OWNER'S AFFIDAVIT:
1 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.
40E-Wn�C_
ONTRACTO$caSIGNATURE
STATE OF F1
COUNTY OF
The foregoing
,before me this
,p6ent kno;aged
day of Vtil gg�� ��by
:�, who is personally
�Sig��elofNo/tA \_
Type or Print Name of N
id
LORIE A. GERSTEIMER 11
MMISSIdN # DD 514317
;� IRES: February 14, 2010untimftm
CONTRACTOR SIGNA
STATE OF FL�
COUNTY OF S1711—
The foregoing
be ore n e t
ntomec
Type or Print Name of Notary
howled ed
20
personally
Commission No. (Seal) Commission No. (Seal)
LORIE A. GERSTEMEIER
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATU = 4 � BE I 51 17
�ond�A�20f0 A PLYING FOR
THIS BUILINC PERMIT AS AN OWNER/BUILDER, THE O P AR TO SIGN
THIS APPLICATION IN THE OFFICE LISTEWON THE FRO N
For specific instructions see appropriate permit checklist.