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HomeMy WebLinkAboutApplication for Zoning Compliancey _ OFF�CE��E OI�L,Y: DATE FILED: 0 PLAN REVIEW FEE:() • © V RECPIPT NO.: ,2j PERMIT NUMBER. CONCURRENCY FEE: DC• 6 0 . RECEIPT NO.: CERT. CAP. NO.: 1. 2 3 4 5 9 ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED 4- St. Lucie County Building and Zoning •.FF 2300 Virginia Avenue FOR\Op Ft. Pierce, FL 34982-5652 772-462-1553 %D ,1 11 44WV_11� APPLICATION for .BUILDING PERMIT �1 CERTIFICATE of CAPACITY/ZONING COMPLIANCE LOCATION/SITE ADDRESS. S/D NAME: PROJECT INFORMATION i rJ, us t-Itj,/ 1 , Ff . (e;er•ce , F t 3419'rCv SITE PLAN NAME: PROPERTY TAX ID # t1E33 " 1 -3�0 --Oa 10 do b 5 LEGAL DESCRIPTION (attach extra sheets if necessary): PLAT 6. PAGE 7. BLOCK 8. LOT 3 BOOK NO. NO. NO. PARCEL SIZE: ACRES/SQ FT. 02/ LOT DIMENSIONS X 10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: hl,ied l!!12b 1e `�ay1�e, 7-le' ©.b �+ ne)ii ce,r�n�es(1i' 11. SETBACKS (ACTUAL) FRONT: BACK: o RIGHT: � . SIDE SIDE �""' ACC I�jt .7,5 6, a..5-( 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: S F 14. Sq. Ft./CONSTRUCTION:y 15. Sq. Ft. 1st Floor: ? 7 O o� 16. VALUE OF CONSTRUCTION: 1 I4, ®a � 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. j SLCCDV Form No.: 001-02 r OWNER INFORMATION NAME: ,54-. l �,.aia �d !�1 (L" ' a ADDRESS: Pb ZIP ' -�-s� �� STATE: � r =����f�"� c'��a7% CITY: A e � S 3 �_ f � 210 email: PHONE (DAYTIME): ( ) 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 #: F 7 T ST. LUCIE COUNTY CERT #: �y BUSINESS NAME: 15Ga QUALIFIERS NAME: -Fv z4Vkn C ADDRESS: T r c-�-c e CITY: � STATE: I ZIP y 7� PHONE (DAYTIME): (3} ��� _FAX NO. `77� )�< email: ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: STATE: 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. OFFICE USE ONLY SECTION •�3 TOWNSHIP J?4.s RANGE �� MAP NO. 14/339 ZONING IW LAND USE 0A LOT CVG % TAZ NO. FLOOD ZONE x FIRM MAP # I�, 1ST FLR ELV MAX HGT CONST TYPE OCCUR TYPE MAX OCCUP # OF FLRS WATER t..e► tl SEWER u,• �U SPRINKLERS STORMWATER LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT (before 1/90) 1/90) REQUIRED APPROVED ADMINST LIBRARY ARKS hMPACTFEE PERMIT 2� VARIANCE IMPACT FEE FEE i REPORT 01 PUBLIC BLD HABITABLE RADON FEE CODE 0-7 IMPACT FEE AREA (RADON) SCHOOL M&n— GROSS,ROAD CREDIT Y N TOTAL -ROAD IMPACT FEE �G% IMPACT FEE IMPACT FEE DUE SCHOOL CREDIT Y N ' ' s, TOTAL IMPACT FEE � � `fi � �`� s SCHOOL IMPACT FEE POLICE FEE FIRE FEE MISC FEE TOTAL POLICE/FIRE MISC FEES TOTAL ADDITIONAL Y N SPECIFY PERMITS of ALL REQUIRED -FEES ZJ MANGROVE REVIEWS ZONING ZONING PLANS MISC. VEGETATION• _SEA TURTLE REVIEWED BY EXAMINE DATE 9 Or COMPLETE - LIAA-- I INITIALS 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 bejperformed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits may be regti{ired 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- resi ential use. N TICE 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. OTICE 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. 0 NEWCONTRACTOR SIGNATURE CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF �54 The foregoing instrument w acknowledged be ore me this /0 day of , 20'� r, by is personally kno n to me or whQ has produced as identification. Signature of tart' Type or = an 3 ehof(NC1i��9JON # DD 633047 r 4 EXPIRES: March 6 2011 Bonded Thru Notary P Un rxrt.t.. Commi -- - STATE OF FLORIDA , COUNTY OF C G t 2 The foregoing instrument w acknowledged before me this day of�, 20A7by ho ' personally �R *, kno n to me or who has produced 10 as identification. s. iXpC -V 3? Signature of N ry f l/ y Type or Pri ame of Notary Commission No. (Seal) 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. sr Py�•. AUDREY B. HUMPHREY MY COMMISSION # DD 633047 <€ EXPIRES: March 6, 2011 a'�,�• h Bonded Thru Notary Public Underwriters