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HomeMy WebLinkAboutZoning Compliance�l DATE FILED: 6 ' �S% p S PLAN REVIEW FEE: ��17D•077 RECEIPT NO.: ���4� PERMIT NUMBER ® ®"' CONCURRENCY FEE• X-6-0 RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE st FILLED IN TO BE ACCEPTED �J OGy ST. LUCIE COUNTY PUBLIC WORKS LN t ® cp, � BUILDING & ZONING DEPARTMENT )' - FORTP VIRGIERCE, F AVENUE _ FORT PIERCE, FL 34982-5652 - -. 772-462-1553 - APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE 1. 2. 3. 4. LOCATION/SITE ADDRESS: S/D PROPERTYTAXID#: PROJECT INFORMATION ild(cl 4 - icii ' us awe LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT_. SITE PLAN NAME: Cvd 1—Z. 4 7. BLOCK LOT BOOK / NO. .3rj NO. NO. /01 6. PAGE PARCEL SIZE: ACRES/SQ FT. A n� LOT DIMENSIONS DESCRIPTION OF/FCONSTRU TIONPROJECT ORWORK ACTIVITY: // SETBACKS (ACTUAL) FRONT: � BACK:220 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [G}''NEW CONSTRUCTION [ I EXPANSION/ADDITION [ ] RESIDENTIAL [q' COMMERCIAL [ I OTHER (SPECIFY) �r �Qy,, LEFT SFfUJ SIDE: [ ] INTERIOR RENOVATION' [ ] INDUSTRIAL 13. AI=SCRIPTION OF PROPOSED USE: 14. $�; Ft./CONSTRUCTION: 15. Sq. Ft. 1st Floor: 16. VALUE OF CONSTRUCTION: $ The value of construction is used to determine the amount of -te permit fees to be assessed. St. Lucie County reserves the right to question and/or modify thro indicated vatire of construction if it is demonstrated that the submitted figures are not coilsistent with similar types of construction activities. If the value is $250 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 OWNER INFORMATION: NAME: ADDRESS: CITY:STATE: yL, ZIP 3SZv gr/ 7 PHONE (DAYTIME):J-„rLn�� IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. �uJne- FEE SIMPLE TITLEHOLDER: l/h 4W ADDRESS: CITY: - STATE: ZIP PHONE (DAYTIME): ( ) CONTRACTOR INFORMATION, ST. of FL REG.ICERT #: (gc 060Z 3 g ST. LUCIE COUNTY CERT #: Pryev/ s BUSINESS NAME: _ f r AIL/ QUALIFIERS NAME: SaSN .WJ.L. ��'� .S, v'1,`'. ... i' ADDRESS: L✓��; STATE: CITY: .Z�IPp, PHONE (DAYTIME): FAX NO. S-33L� I�73 ARCHIT/ENGINEER:'!. ADDRESS: CITY: 'STATE ,.:gip � Q t-- -��?yy'l'u /y PHONE (DAYTIME): 1TT4 ZZ' . C(� �.T f/ BONDING COMPANY:h/Zi ADDRESS: CITY: STATE: ZIP MORTGAGE LENDER:i5�"l_�,/UGv(_.`°" ADDRESS: CITY: �Y�, tree h.'l, - STATE: ZIP �J•. 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. OWNERIC/91NfRACTOR SIGNATURE STATE OF Ft-G+ IBA f1 labar<,a. COUNTY OF Je_-ffiersoh The foregoing instrument was acknowledged before me this -it day of uoe , 200�;, by &}(gn Z e , who is personally known to me or who has Oroduced as identification. Signature of tary Type or Print ame of Notary „ a L Public Title =- f omrnission Number =4sealj - ' CONTRACTOR LATU E STATE OF PIBA AIabavhq- COUNTY OF er5ov�_ The foregoing instrument" was acknowledged before me this. day of Mpg, , 2005 , by Ia __Cubk, who is personally known to me or who has ro uce as identification. Signature of Nobry Laura Wvon, Type of Print Nafne of Notary ota Public Title J &ammission Number Np,' f TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUSTBE NOTARIZED. FARF-PPLY1NG FOR THIS BUILDING PERMIT AS AN OWNEF;VU DER, THE OWNER MUST PERSONALLY APPEP TA&jGN THIS APPLICATION IN THE OFFICE LISTED ON TIZ—FRONT OF THIS APPLICATION. ® r = / SECTION: TOWNSHIP: RANGE: MAP NO.: ZONING: LAND USE: e LOT CVG %: TAZ NO.:. FLOOD ZONE: v FIRM MAP #: /2 1 ST FLR ELV: MAX HGT: CST TYPE: Y ( OCCP TYPE: MAX. OCCP: # OF FLRS: WATER: /// SEWER:. �L SPRINKLERS �STORMWATE R LOT OF REG (beG 1/90) LOT OF REC (aft r 1/90) LOT SPLIT ,. LOT SPLIT REQ'D IAPPRV'D 0 DECAL LIBRARY PARKS PERMIT NUMBER _:IMPACT FEE IMPACT FEE FEE REPORT 131w, •PUBi,IC BLD g- HABITABALE RADON FEE CODE f ACT.FEE AREA (RADON) _ Y N ROAD r1 ' GROSS ROAD CREDIT TOTAL ROAD IMPACT ZONE IMPACT FEE IMPACT FEE DUE ff /} Z Y N SCHOOL CREDIT TOTAL IMPACT FEE '-� ' �" w .� SCHOOL t IMPACT FEE FIRE FEE MISC FEES: TOTAL / 2 PO ` F �.J • M SLC. FEES 01 ADDITIONAL SPECIFY: ) /um 131 TOTAL ALL PERMITS © - FEES REQ.D REVIEWS ZONING ZONING - �~ P"JkNS ._ _ VEGETATION SEA =r.: I;ryGROVE . REVIEWED Bl' - EXAMI[NjI`gNG TURTLE DATE COMPLETE INITIALS /� '