HomeMy WebLinkAboutZoning ComplianceDATE FILED:
PLAN REVIEW FEE: RECEIPT NO.:
J PERMIT NUMBER (! Cl ��` • G '
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
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ALL MFO MUST HE COMPLI t & F-ILLLt ) INTO lit AC UEFTt Ul
St. Lucie County Building and Zoning 0q"2300 Virginia Avenue
.
'n�OR1O Ft. Pierce, Fi, 34982-5652
772462-1553
(77 7-7
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
LOCATION/SITE ADDRESS:
S/D NAME:
PROPERTY TAX ID #:
%2 /PROJECT INFORMATION
u. t j
SITE PLAN NAME:
l- l Ql,a - j—" G
LEGAL DESCRIPTION (attach extra sheets if necessary):
PLAT 6. PAGE 7. BLOCK $. LOT
BOOK NO. NO, NO.
PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS
DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:,
L�Tizl • C. S f{r�s
_<372 p %J%oLL
SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT:
SIDE SIDE
12. TYPE F CONSTRUCTION (Check all appropriate boxes)
[�W CONSTRUCTION [) EXPANSION/ADDITION [) INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [) INDUSTRIAL
] ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. Sq. FtJCONSTRUCTION: _
16.
Sq. Ft. Ist Floor:
VALUE OF CONSTRUCTION: $ OOP!
I5.
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 d t
s GRDWNB ST Z ✓G/f ASDG/dfEj 4rew�G� l ar a€✓b k� p
NAME:—r—
ADDRESS. Q /L &7w 26 lR 5k,�te 'Y015
CITY: r RyJ )v /✓i s' STATE: %JL ZII
PHONE (DAYTIME): 0QSj �2 %3 ^.3�2 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):
curvi rww, i un inrunivin s wn
ST. of FL REG./CERT #: e QCOI,ot :2 3 18
BUSINESS NAME: 4, E , C
QUALIFIERS NAME: &2rr7 42
ADDRESS: A?oeia D l>f
ST. LUCIE COUNTY CERT #:��
CITY: — a`� J ///Am STATE: i 1L- ZIP
PHONE (DAYTIME): ti��31. FAX NO.email:
ARCHIVENGINEER:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME): )
BONDING COMPANY:
ZIP
ADDRESS:
CITY: STATE: ZIP
MORTGAGE LENDER:
ADDRESS: =
CITY: STATE: ZIP
IMPORTANT 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.
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 TIM 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. Q
OWNER/CORAJ7TOA SIGNATURE CONTRACTOR SIGNATU
STATE OF RL/A iMA STATE OF /yl�A FS{ /M
COUNTY OF COUNTY OF �E�Fe✓Soh
The foregoing instrumentw acknowledged The foregoing instrument was acknowledged
b fore me this day of , 20 by before na this May of 20b- by
who' personally to who is personally
known to me or a a haspreddsed known to me o
Signatulf of Notary V SignAt6r&ofNotary
L-.CIU C, Vj n y L—OU,P4 VAhh
Type or Print Name of Notary Type or Print Name of lNotary
Commission l�0:. (Seal) Commission No. `� -' (Seal) ;
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNERlBUILDER, 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.