HomeMy WebLinkAboutApplication Zoning ComplianceP b
DATE FILED: + �'
PLAN REVIEW FEE: c. - 00 b 0 - RECEIPT NO.: �� PERMIT NUMBER: V 0 �%' OL
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. -Lucie County Building and Zoning
2300 Virginia Avenue
• ° OR10�. Ft. Pierce, FL 34982-5652 -
772-4b2-1553 � �B/ � ! � 1�
711c)-r p N 660 P-T
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: QgtO MM'L-*F,, ilk
2. S/D NAME: /19 ,, 6_UVn( `PL Rim_ SITE PLAN NAME- /� �-
3. PROPERTY TAX ID #: �� ro 0,3 ' ' �� 0 � U� • ( �V • �O D
4. LEGAL DESCRIPTION (attach extra sheets if necessary): uAkL - /" d - GK eoT ko ;5
(;>7a n,157
5. PLAT 6. PAGE 7. BLOCK B 8. LOT
BOOK 0 NO. 6 NO. f
9. dPARCEL SIZE: ACRES/SQ FT. O;a;l X 2 LOT DIMENSIONS �O `5 0 r 12-5
f 8-7 50,bb
10.0 DESCRIPTTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
t'2irM(AtaAL,Ce MG=iAL _GR 1
La r1_9
11. CSETBACKS (ACTUAL) FRONT: I BACK: j RIGHT: 2� LEFT: /
SIDE SIDE 87
12. v TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION, EXPANSION/ADDITION [ ] INTERIOR RENOVATION
(] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
Pa OTHER (SPECIFY) #)�t/Ltc :62L�'� 136d Ja ?�
13. DESCRIPTION OF PROPOSED USE:
14. Sq. FtJCONSTRUCTION: d"e 0' 00 15. Sq. Ft. 1st Floor:
O
16. () VALUE OF CONSTRUCTION: $ I j2�30�
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
NAME: P r u'
ADDRESS: 5
.CITY: STATE:... ZIP' )�
PHONE (DAYTIME): '-- 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. 6f FL REG./CERT #: 0 V W - ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP
PHONE (DAYTRvIE): FAX NO. email:
ARCHIT/ENGINEER:.
'ADDRESS:
CITY: YQ-(1 Gt �2 �.,Z 1 STATE: ZIP
PHONE (DAYTIME): (y2 ) ' � �( Cos
BONDING COMPANY:
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 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 AFFIDAV • I certify that all the foregoing information is accurate and that all work will be done in compliance
/ with all aple laws regulating construction and zoning.
z�
-; 2jy 9U0
cDER%CONTRACTOR SIGNATUREaFtp�2�,y��S6,yG�A
adz y9�cy
STATE OF FLORID
COUNTY OF ���
yF� 2�a��#�
obi°La2p�j 3g)
The foregoing instrument was a owledged
�ynlP�s !
�s:*'gip,•.,
befare_ne this day of WV. 20� by
mi
{�LCli7�/vho.is personally
known to me or who has produced
�Q •.Z.LC'i as identificatiwo
41
rt{
Signature o otary
T
a iv�9
0
�v
Type or Print N e of Notary
Commission No. (Seal),
,
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowle ed
before me this _day of Iby
who ' personally
known to me or who has
/ as identification.
Signature gfNotary
or Print Name of Notary
Commission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, 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.