HomeMy WebLinkAboutZoning ComplianceOFFICE tP. SE ONILY
DATE FILED:
PLAN REVIEW FEE:
1� CONCURRENCY FE
�a� any
r/•O� RECEIPT NO.:
PERMIT NUMBER: 9Zy10 Kj':
ALL INFO UST BE COMPLETE ju FILLED IN TO BE ACCEPTED
�Jp\6 coG ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 - � RTPIE PIERCGINIAE,
AVENUE
20R\OQ FORT PIERCE, F1 34982-5652
561-062-1553 �, s
(��J`— APPLICATION for BUILDING PERMIT
S� CERTIFICATE of CAPACITY/ZONING COMPLIANCE
1.
2.
3.
4.
PROJECT INFORMATION
LOCATION/SITE ADDRESS: I I /' �FaRB�1�ku15
S/D NAME: FIC-4 V tLL.�k6E SITE PLAN NAME: 1741% 64�t_F Cu.L$
PROPERTY TAX ID #:
LEGAL DESCRIPTION (attach extra sheets if necessary): SEr- Sat2\3WN
5. PLAT 6. PAGE 7. BLOCK
BOOK NO. NO.
9. PARCEL SIZE: SO FT. LOT DIMENSIONS `f
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
8. LOT
NO.
Li'�;k
Got_F- C-0LLk5 g lewt }Rct>K
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
EB.D 10. 0 SIDE SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION
[ ] RESIDENTIAL
�Q OTHER (SPECIFY)
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
F[ ] COMMERCIAL eWt4zt � [ ] INDUSTRIAL �
13. DESCRIPTION OF PROPOSED USE: 'j>6 C3u G FA}Ct ug-4
14, Sq. Ft./CONSTRUCTION: 51 Z 15. Sq. Ft. 1 st Floor:
16. VALUE OF CONSTRUCTION: $ Z'b O 40
Thevalue of construction is used to determine the amount oft. modlily e
indicated value of construction if it is demonstrated that the submitted figures are not consistentwith similar Lucie ounty reserves fhe right to question and/or r" $;Mo
or rtore, a RECORDED Notice of Commencement must be submitted with this application. h'pes of construction activities. If the value is
SLCCDV Form No.: 001.02
OWNER INFORMATION:
11 ,
NAME: �T ->
ADDRESS: l's I S V,,\t
CITY: ?0v<r S'C Lzy--1a STATE: ZIP 34a a <�
PHONE (DAYTIME): ! ) `F ,l - I JCXo
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
ST. of FL REG./CERT #: G&—� OA-I OS ID ST. LUCIEI (COUNTY CERT #: 1174,86
BUSINESS NAME: KOL-rS�i
QUALIFIERS NAME: RCMVfT Vk-11 .
ADDRESS: _ Zl(� ICI W i-NsRR,4E- P,TRK-TT-A,-s
CITY: 'bTKr S-C LLtcm STATE: FL ZIP
PHONE (DAYTIME): (77Z) 444.s 14763 FAX NO. 4lfg- L4/-03
ARCHIT/ENGINEER: DA•VID MILLER * �SSOCl,QT1=s � Q A,
ADDRESS: 24�9D 'PAL.K BFACu LXKeiS $Luy A 2Q5-
CITY: WEST rN-Lm 3spr-� STATE: T:�L ZIP
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LcNDER:
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.
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 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.
OWNER/CON TOR SIGNATURE CONT TO SIGNATURE
STATE OF FL DA STATE OF FLORIDA
COUNTY OF COUNTY OF
The foregoing instalment was acknowledge The foregoing instrument as acknowledged
befo a me this .�i day oft 20G 4 by- b fore me this �a r of 20 O b
�-�- ( o is ersonaal kno n to me r who ��C —�, ho is person know e
atri s prod d /� as identification. �qr\,_who K s produce as identification.
3fgnglf ire of Notary
L_YtJf Cy-t0044.c
Type or Print Name of Notary
Notary Public Title
of Notary
/�-Y,dnJL tFoo�
Type of Print Name of Notary
Notary Public Title
Commission Number Commi
(sea) LYNCommM#ODD0232858 LYNNNE MOORS
Expires W02007 (seal) Gomm# DD0232868
Bonded dtru (800)432-4254 � xpires W2WW7
Florida NotaryAssn., Inc. (800)432.4254
NOTE: Florid. Not. Assn:, Inc. 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.
BP #:
OFFICE
USE ONLY
SECTION:
�°-/
TOWNSHIP:
�- VJJ
RANGE:
MAP NO.:
3�3�5 IV
ZONING:
I V 1�
LAND USE:
rl- %"
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP #:
1ST FLR ELV:
MAX H
CST TYPE:
OCCP TYPE:
CCP:
—MAWATER:
# OF FLRS:
SEWER:
/�p,yj �'I�I
SPRINKLERS
STORMWATE
R
LOT OF REC (befr 1/90)
LOT OF REC (aftr 1/90)
LOT SPLIT
LOT SPLIT
REQ'D
APPRV'D
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT FEE
IMPACT FEE
FEE
J
REPORT
u
PUBLIC BLDG
HABITABALE
RADON FEE
CODE
�.')
(�(�
IMPACT FEE
AREA
(RADON)
Y
ROAD
GROSS ROAD
CREDIT
TOTAL ROAD
IMPACTZONE
IMPACT FEE
IMPACT FEE
DUE
h/
Y
N
SCHOOL
CREDIT
'
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
F FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES
Y
N
ADDITIONAL
SPECIFY:
TOTAL ALL
PERMITS
FEES
REQ'D
REVIEWS
ZONING
ZONING
PLANS
I
VEGETATION
I
SEA
MANGROVE
REVIEWED BY
TURTLE
DATE
COMPLETE
JJEXAMINING
INITIALS