HomeMy WebLinkAboutZoning Compliance'OFFICE USE ONLY,
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DATE FILED: _ I PLAN REVIEW FEE: RECEIPT NO.: ' I 1 / PERMIT NUMBER: I 0 A 1
00(00
00NCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE.REGULATIONS DIVIpSIIO�NC
2Pie Virginia Avenue
Pie
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIAN�
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: (0 8 /1 AX,, 1A1PE Ac .
2. PROJECT NAME: C`' D (,ja 1-6 n LL-C- �I 11�- SITE PLAN NAME:
3. '-PROPERTY TAX ID #: 3 Lf S - 100- C7Oo(oOZO —O
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
�-
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): • q T LOT DIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: R te iaA1
S�LTanJ o� ao.0a2ciE ojh#2KmN6r LcT f- IfiW c, wiTil' oJEW
11, SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ 1 COMMERCIAL [ ] INDUSTRIAL
[.]OTHER (SPECIFY) J�&rADy t,(L Zit SAJi5:- d,44eK1AJC- 4Zr ..
15. 'DESCRIPTION OF PROPOSED USE: dl+,fK,,AJ6- 4 T
14. SQ. FT OF CONSTRUCTION: /S8® 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $ "Z�.OD
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
UPDATED 6/25/09
OWNER INFORMATION
NAME: Sri 5 tins LJ" I ta^ (: 11 ij` t/ (,u ftt-JU/V // U-
ADDRESS: of"?S Char�PaSna CI. Sw 'dl • 3i
CITY: V e r u 17ea c)^ STATE: ZIP: 319 6 %
PHONE (DAYTIME): 771 y73. 9/ 9-2 Email: cap --
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): �)
CONTRACTOR INFORMATION C p�
ST. of FL REG.CERT ST. LUCIE COUNTY CERT #: �ITO
BUSINESS NAME: C91�e
QUALIFIERS NAME: r \r
ADDRESS: a O vac CITY STATE: STATE: ) ea% AA
PHONE (DAYTIME): FAXNO. o S�00k Email:
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): C__)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP: 3 �i 11 E -)
ZIP:
ZIP:
ZIP:
EWPORTANT 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.
Z-
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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
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: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST. THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNE O CONTRACTOR SICUATURE
STATE OF FLORIDJ/� �,
COUNTY OF { 1 lLjl., a
The foregoing instrument was acknowledged before
me this �iyiy of 20 �
by ° /
who is personally known V/ or has produced
as identification.
Signature of Notary . : •'• . A PC+ORBAUt"aH
* * MY COMMISSION # DD 804566
EXPIRES: August 4, 2012
Commission No. "'+" 1)eondedihmeudgetNotaryservhes
OF
P�,4 '�,
CONTRACrRYIGNAT
STATE OF FLORIDA
COUNTY OF r'�\
The foregoing instrument was acknowledged before
me this2alay of QJ7 20 ,
by
who is personally known or has produced
of Notary
Commission No.
as
MY COMMISSION # 0 804566
-OrNFS) August 4, 2012
BcndadThntBudiplNoty!Servke`s
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS. AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #:
SECTION
`
TOWNSHIP
RANGE
L/-0
MAP NO.
[ A5C
ZONING
(�
LAND USE
n Wj
/
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FIR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
F REC
After U1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
,, /
HABITABLE
I
RADON I
PERMIT