HomeMy WebLinkAboutZoning Complianceam NIVAHM.: 417 DATE FILED e /5/'D ,dj •.� t f�
PLAN REVTEW FEE: RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
T BE COMPLETE & FILLED IN TO BE ACCE
AZG s
St. Lucie County Building and Zoningx�i
2300 Virginia Avenue
ALL INFO
401 P1.
ORIp�'` Ft. Pierce, FL 34982-5652
... 772-462-1553 cee
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT �'IINFORMATION
1. LOCATION/SITE ADDRESS: A ,`> /. &I r" 1� // e`l IC[ l le
2. PROJECT NAME: C4 V l V C tW A w �;SITE PLAN NAME:
3. PROPERTY TAX ID #: a 3 o'Z �' D It O r0 / 7 t0 0 O' p
4. „;fit:. LEGAL DESCRIPTION (attach extra sheets if necessary): FL �}- CO%¢ T L / lV g c14-1y 4L
ofr'L T► AN-s CC s S//) F-.eoM /VL-1Cote Lo7-/1 2/n..i i= />ar=
5. PLATBOOK 6. PAGE NO. T 7. BLOCK O. 8. LOT NO.
kFo
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:. K 1.
$,5 5D
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
�I ,Je rj &V=o� /� s`x �� �„ 71arrr Oooy
11, SETBACKS (ACTUAL) FRONT: t Cam' .— BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes) -
[) NEW CONSTRUCTION [ ] EXPANSION/ADDITION - [ ] INTERIOR RENOVATION
[t.]� RESIDENTIAL [ ] COMMERCIAL [ ] .INDUSTRIAL
]. OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: Gp
14. SQ. FT OF CONSTRUCTION: _� 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $
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 we 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
d
OWNER INFORMATION
%
NAME: S-h
ADDRESS: ( Q Tn- ". L
CITY: - r-4-- Y7STATE: ZIP: 3 Y
PHONE (DAYTIME): (72� 3 - a 8 6 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: STATE:..: ZIP:
PHONE (DAYTIME)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME: V VF
QUALIFIERS. NAME:
,+
ADDRESS: ! _ �_�._14_ciL
CITY:
PHONE.(DAYTIME)i
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): (_)
BONDING COMPANY:
ADDRESS:
CITY:
ST.LUCIE COUNTY CERT #: G
STATE: / L � ZIP: 3 �✓��_r_> _—_
FAX NO. Email:. •
STATE:
STATE:
ZIP:
ZIP:
MORTGAGE LENDER:
ADDRESS:
" CITY: STATE: ZIP:
EAPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will he 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.
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 yourdeed 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: 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. workwill. be done in compliance
with all applicable laws regulating constructio d zoning.
OR CONTRACTOR SIGNATURE CON CTOR SIGNATURE
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF •S rt L rti Ce e' COUNTY OF :- —, I C a
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this _�_ day of ��,._7�20 me this Z day of , 20i,
by by D V1
who is personally own - or has produced who is personally own or has produced
L. f.
as identification.
tde fication...
--a
Signature of a 'Siguaturereffary
AUDREY B. NUMPHR) 7
a,,,,, g99QQ'�8
Commission MY COMMISSION# Y (Seal)
'• EXP S. March �w AUDREY S. HUMPHREY
•R..' aondaatn NoarvPub4cunderedter' iakS'' f MY COMMISSION# DO 633047 "^S 2011 .Bpnde TbN NMarytPoU archU,d,,Otar
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EAC ZED. 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 #: 0O .
SECTION
2�
VC
TOWNSHIP
RANGE
Lt
I/
MAP NO.
ZONING
J
LAND USE
�J� /J
(�j/I
LOT CVG %
//
TAZ NO.
/7
✓�
FLOOD ZONE
FIRM MAP #
l O
O /
1ST FLR ELV
v
MAX HOT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
��( W`Q0 (�
SEWER
'
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
.LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
' AREA
HABITABLE
(RADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BLD
IMPACT
FEE -
GENERAL
PARKS
IMPACT _
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
DIT
Y
N
LAW ENF
IMPACT
FEE
FIRFJEMS
IMPACT
FEE
DRNEW
D
Y
N
—
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCEFEE
SPECIFY
SUBS
REQ
C — ROOF _
ECTRIC GAS
PLUMBING —
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
.SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
q I
DATE
COMPLETED
D
INITIALS