HomeMy WebLinkAboutApplication for Zoning Compliance6—F F 16 f USE ONLY
DATE FILED: - ! `
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST.BE COMPLETE & FILLED IN TO'BE ACCEPTED
DEVELOPMENT SERVICES DEPARTMENT
ING & CO REGULATIONS DIVISION
2300 trgtma Avenue
5 Pi ce, FL 34982-5652
779=462.1553
APPLICATION for ,.BUILDING PERMIT �-
CERTIFICATE. of CAPACITY/ZONING COM IANCE.
PROJECT INFORMATION
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1: LOCATION%SITE ADDRESS: 2 �J�I' I Iti1lu�To�l fzoA�p . f%Q _T. ST. Uy de . Ft. 3 t GI ro Z
. sovpaNc�s � s�rosnlr� sEa.►vc. � P�-
2. PROJECT NAME: EDtWjMar1 CAe ., EY, SITE PLAN NAME: 1EpJL 1M
3. PROPERTY TAX ID ® oo - 2 St�E Pr.�N fr i�
4. LEGAL DESCRIPTION (attach extra sheets if necessary): ST LAje-t£ 00-A ' 4S
31 3 Co l &.k. 4 l.o't;S An, E5. G -LESS ft6P Sb W (14. &S ACRES) C n1AP �S�315� �of�-
5, PLAT BOOK _ 6. PAGE NO: 3 _ 7. BLOCK NO. 8. LOT NO.
Qoo-lcotco)
A, tiej C. IE55 Ive"
t�•tt�4rf-oF-WAY
9. PARCEL SIZE (ACRES/SQ FT.): • ` . (p 3 LOT DIMENSIONS; '(,p30%x 1 01 x (03d x °! 010t
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: QODt "Tz eKsTibga
UISI'T 6 ceNTeF- — LeXa sq Q-/(rA9wAN0do UtruA.e_ fr► VMW ENFAMsk:4 .
' !nlm� St2uatNtE ors Corse . PcE�RrS +� YIE�fVI WAtU. Fovncna.-TccN ntt�u /fl�•.� FUcrng�y �]ttnt�
I I. SETBACKS (ACTUAL) FRONT:. BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[� NEW CONSTRUCTION [ EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: &Dvmw Teo t=jV Silt VI.SI'%g& cemyee-
14.
16.
SQ. FT OF CONSTRUCTION: �j, O `I' �• 15. SF. FT 1 st FLOOR: d �a
VALUE OF CONSTRUCTION; $ �J I �'", O 13
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
(D.O/Z2Sy s 3j3,a/2. Zo6
UPDATED 6/25/09
3,320 aE�k
.. 7
OWNER. INFORMATION
OMG M��-Ve�*—U�'(.Mt4 t�JsStn�SE�cTc4hf
NAME:: �lt�l I`JiL�.RTR -' FSVAt� Df� AtPx.«�C,ntu� A►OMtnitS7t2�'Tt�o�
ADDRESS. 3%00 60M-ffif) WEMMA P. 0 me? 430 �,: of tutP.o�my�d -
. tom.. .
CITY:STATE:.. ZIP:
PHONE (DAYTIME): gpo).. 2 Amp . 212G Email: yi xoe , m D-TI oa mr. SThm FL. US
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED.ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.. .
FEESIMPLE TITLEHOLDER: S�►M{E .
ADDRESS:
CITY: STATE; ZIP.
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST, of FL REG.CERT. #:.. ST. LUCIE COUNTY CERT. #: .
BUSINESS NAME: .
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: .. ZIP:
PHONE (DAYTIME): ( ^) . • FAX NO: Email:
ARCHIVENGINEER: 1-i _ '� '1 i� 11 �' 1 � t�SiyfLb�
ADDRESS: s( [ . �(�(J( FLV 7R ();, .. UZTE GOO
CITY: 171V1ca-1 STATE: ZIP:
Iv 1
P PHONE (DAYTIME): 7foU �'2 (, - S 130
BONDING COMPANY:
ADDRESS: .
CITY:
MORTGAGE LENDER:
ADDRESS -
STATE:
ZIP: .
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.
S
CERTIFICATION:
This application is herHerebymade to obtain - a permit to do the work and installations. as indicated, and to obtain a certificate of capacity,
if applicable, for the pqmittedwo& I certify that no Work or installation, has commenced prior to the issuance of a permit and that all
work will beperformed tdmeet the standards bfall laws regulating coiri construction ihisj.urigdi.6tioii. 1 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. Liicie County makes no r6presentati . on that its granting of'a permit will authorize the permit holder to build th6 subject structure
ructure
which is in conflict With anyapplicable Homeowner Association 'rules, bylaws or any covenants that may restrict or prohibit such
structure. Plea'se':Consult With your HomedWtier's Association and review your deed f6r any restrictions Which may' apply.
The following building permit applications are exempt from undergoiik a fiill concurr enoy 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 IMPRQVEMENTS' TO YOUR. PROPERTY. A NOTICE. OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND T.OOBTAIN, 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 THISPERMIT, YOU, PROMISE IN.
GOOD FAITH TO DELIVER A. COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER ORAWWW-011 SIGNATURE
STATE OF FLORIDA
IDA
COUNTY OF
The foregoing instrument was acknowledged before
me this , . day of
by
-2.0.
Who is personally known or has pro.duced
.. as identification.
Signature of Notary
Commission No. (seal)
MMM-R SIGNATURE.
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was -acknowledged before
,me- this _-LL�ay of
by.
who is personally.kno"wn or has -produced
as entitica id tion.
i
Signature of Notary
Commission No: (seal)
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.
OFFICE USE ONLY BP #:.. ... u
SECTION
TOWNSHIP
RANGE.
MAP NO.
ZONING
h�
LAND USE
LOT CVG %
TAZ NO,
FLOOD ZONE
x Q I�
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP :
# OF FLRS
WATERLk
SEWER
Lc .
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT .
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMITCODE
boa
AREA .
FEE
FEE
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORRECTION
FEE .
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
-
FEE .
FEE
FEE .
FIRE/EMS ,'
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
.FEE
SPECIFY •
MECHANIC ROOF ..✓
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING �;-f
FEES
DATE SENT TO ADDRESSING:.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW .
REVIEW
DATE
RECEIVED
DATE
COMPLETED .
INITIALS