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HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY: DATE FILED: PLAN REVIEW FEE: �= RECEIPT NO.: V� PERMIT NUMBER: —0 CONCURRENCY FEE: t2 ' RECEIPT NO.: CERT. CAP- NO.: s - �1 ALL INFO MUST BE COMPLETE.& FILLED IN TO BE ACCE ]gD N' St. Lucie County Building and Zoning 2300 Virginia Avenue 10R1� Ft. Pierce, FL 34982-5652 772-462-1553 , APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: 2. S/D NAME: CO) or i C 111.1.�7 SITE PLAN NAME: I O SS e 3. PROPERTY TAX ID#:� I.'LO DDlOr ODO� -� 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT 6. PAGE 7: BLOCK- ' 8- LOT BOOK NO. _7_�L NO.:. - NO. +5 9. PARCEL SIZE- ACRES/SQ FT- 1u a LOT DIMENSIONS 10. DESCRIPTION OF CONSTRUCT PROJECT OR WORK ACTIVITY: 11- SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT: t, 5 SIDE `�� SIDE p( 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ jNEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION ] RESIDENTIAL ] COMMERCIAL 1 �1n [ ] INDUSTRIAL OTHER (SPECIFY) 1LSe c; 5� ^yjt-. �'L�0051 -- • 144 �?-tnG QeSj� L 13. DESCRIPTION OF PROPOSED USE: \ 61 `. 40ME, 14. Sq. FUCONSTRUCTION: 15. Sq. Ft. 1st Floor: 16. VALUE OF ONSTRUCTION: 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 f NAME: .J • ADDRESS: 6"C CITY:09 STATE: ZIP 94 n PHONE (DAYTIME): email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. , "T, ADDRESS: c � � � CITY: STATE: `�`- ZIP PHONE (DAYTIME): C__) CONTRACTOR INFORMATION ST. of FL REG./CERT #: �� - DbO�I 7 ST. LUCIE COUNTY CERT #: ©�4 BUSINESS QUALIFIEF ADDRESS: CITY: ate e e. STATE: "FL ZIP �j g-V 7Y -PHONE (DAYTIME): ) _357—Z-7165 FAX6N0. 35'?—'-k50I. email: ARCHIT/ENGINEER: ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): BONDING' COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: ZIP 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 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 certifyJhat 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 SI NATURE STATE OF FLO13JDA COUNTY OF,1.,C\P_ The foregoing instrument was acknowledged efore me this�)_ da o , 20D� by who is personally ,kngmm to me or who has produced as identification. Signature of Notary Type or Print Name of Notary A.-ta "en aS CONTRACTOR SIGNAT STATE OF FLQFJD� COUNTY OF The foregoing instrument was acknowledged before me thi y of� , 20a� by who is p known to me or who has produce aside fic�CM t3D N � N � � N u 0 QZ Ea of Notary Type or Print Name of Notary Commission No. (Seal) w� Commission No. ( 406 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 ONLY :#: SECTION TOWNSHIP RANGE MAP NO. 3 ZONING LAND USE LOT CVG % TAZ NO. �1 �> FLOOD ZONE FIRM MAP # Is" FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER^ SEWER SPRINKLERS STORMWATER ^ LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT efore 1/90 1/90) RE UIRED APPROVED ADMINST LIBRARY PARKS PERMIT VARIANCE IMPACT FEE IMPACT FEE, FEE REPORT PUBLIC BLD RADON FEE CODE IMPACT FEE a 1 O ) SCHOOL GROSS ROAD CREDIT Y N TOTAL ROAD IMPACT FEE IMPACT FEE IMPACT FEE DUE SCHOOL CREDIT Y N TOTAL IMPACT FEE SCHOOL IMPACT FEE S POLICE FEE FIRE FEE M C EE TOTAL POLICEIFIRE MISC FEES ADDITIONAL Y, N SPECIFY TOTAL PERMITS of ALL REQUIRED • FEES REVIEWS ZONING ZONING PLANS MISC. VEGETATION SEA_TURTLE MANGROVE REVIEWED BY EXAMING DATE COMPLETE_ INITIALS