HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USEsONL y, : �`2r-�
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: l
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
I. LOCATION/SITE ADDRESS: 3?)a2Lj 1 r
2. PROJECT NAME: l SIITE PLAN NAME:
3. PROPERTY TAX ID #:-
4. LEGAL DESCRIPTION (attach extra sheets ifnecessary): L&- - `�
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): r 0 CrOLOT DIMENSIONS:
10. COMPLETE DESCRIPTION OF C�ONSTRU TIO PROJ CT OR WORK ACTIVITY:rv�yr Ne
11. SETBACKS (ACTUAL) FRONT: 60 BACK: — �9 RIGHT SIDE: P r LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ RESIDENTIAL /�[ ]l CO RCI'r [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) 1, I¢, f a," l- .'.- '
13. DESCRIPTION OF PROPOSED USE: R eS jd1,f( w
14. SQ. FT OF CONSTRUCTION: 5-7 5 SF 15. SF. FT 1 st FLOOR:
16. I VALUE OF CONSTRUCTION: $ 0
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: .U/;1_
ADDRESS: 33,3!q jVW Pe-e6;1I &,c
CITY: poi. /,K C i I y STATE:
ZIP: -3y 6 9 o
PHONE (DAYTIME): R70J 3q Q - ma Email:
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
PHONE (DAYTIME): U
CONTRACTOR INFORMATION
STATE:
ST. of FL REG.CERT #: Ce' 0 11 akt�?
BUSINESS NAME: LEI_ Q. (' . r-GASTr<�f iDl)
QUALIFIERS NAME:
ADDRESS: Z S d
ZIP:
ST. LUCIE COUNTY CERT #:
CITY: PA�Aj ifi7Y STATE: El ZIPP:�� / fl
PHONE (DAYTIME): �� Z G 3 ` 3 $ `0 FAX NO. 22 p ?S 5'9 Email: a/ •S/ /,lilS ,0y3'h3 4
ARCHIT/ENGINEER: 4 &QG[ led1 ADDRESS: 'Y17 s-r Coc-m ut Airt
CITY: 5tuar -f STATE: )C7/ ZIP:
PHONE (DAYTIME): (11i) 2, $ I _ SZ SD
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.
).a
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.
STATE OF FLORIDA STATE OF FLORIDA
C
COUNTY OF tee- 6 /L COUNTY OF M A'1�TTiI�
The foregoing instrument was acknowledged before
me this / /7 day of 20_1 '�L,
by
who is personally known or has produced
y'C%JL Sy�S�-yG'.S-Q s identification.
Signature of Not `
JOSEPH OLIVERI
Commission No. ' e� y Pubjo?te o1 Plo6ila
Comm. pue Aug 21, 2016
Commission # EE 828836
Bonded Through National Notary Assn.'
The foregoing instrument was acknowledged before
me this _LZday of v 20�,
by � N � C�ShR-fib Y�j . �,_
who is personally known ►/ or has produced
as identification.
Signature of Notary
:�� S�110��. NEWMAN
Commission No. = MY COMl6i85 0 N EE 880008
or EXPIRES. April 20, 2017
a � Bonded Thru Notary Public undemwriters
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.