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HomeMy WebLinkAboutApplication for Zoning Compliance91 DATE FILED: a ' Li- O"7 PLAN REVIEW FEE: ��-- RECEIPT NO.: ra I l S PERMIT NUMBER: �10 oaro� CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MOIST BE COMPLETE 8t FILLED IN TO BE ACCEPTED y ti� ��I-WSC ST. LUCIE COUNTY PUBLIC WORKS [) BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE '20R\OP -------- FORT PIERCE, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COM' , PLT �.TCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: s \ 2. S/D NAME: _ C�c, ��..� Cc,vZ SITE PLAN NAME: 3. PROPERTY TAX ID #: 1 LI % � �iU'� i c) C)C) L( OGC9 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT. -6. PAGE 7. BLOCK -8. LOT BOOK k NO. NO. NO. 3. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS "14:1�k Y. la4.q Y. I W K ►�-i,o3 i0. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY; Lac, LcJClC 11. ETBACKS (ACTUAL) FONT: BACK: RIGHT LEFT e �Q c.T✓•� �-- �� SIDE ,n/ � �- SIDE: 12. PE OF CONSTRUCTION (Check all appropriate boxes) [] NEW CONSTRUCTION [ ] . EXPANSION/ADDITION [ ] INTERIOR RENOVATION U([ RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL ] OTHER (SPECIFY). 3. DESCRIPTION OF PROPOSED USE: 4. SO. FL/CONSTRUCTION: !'�02 15. Sq. Ft. 1st Floor: 6. VALUE OF CONSTRUCTION: - $ he value of construction is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the right to nuPctinn nnrtinr mnrGfir tha LCCDV Form No.: 001-02 OWNER INFORMATION: AME: DDRESS: ITY: C U / i C STATE:- 1`L ZIP! C� � p THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS -ELOW. EE SIMPLE TITLEHOLDER: .DDRESS: _ - :ITY: - STATE: ZIP HONE (DAYTIME): [ ) :ONTRACTOR INFORMATION .T. of FL REGJCERT #: ST. LUCIE COUNTY CERT #: [USINESS NAME:' ©U7 IUALIFIERS NAME: ,DDRESS: 3TY: STATE ZIP 'HONE (DAYTIME): ( 1 FAX NO. iRCHITIENGINEER: DDRESS: l /-( Bti % �/� U( i / Z© Z. 1-7 :ITY: (!- / xy e � J STATE: =/� ©g 014 ZIP _ 'HONE (DAYTIME): IONDING COMPANY: ►DDRESS: :ITY: STATE: ZIP AORTGAGE LENDER: ►DDRESS: i 'ITY• STATE: ZIP mpORTANT NOTICE: Whenfa- permit. is issued and it is not picked: -ups within:.6.0: days j -3fter 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; -ASA 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. 8 MEMR- ,F,�D/�`YIT�a� � 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-. 4;&0001-1 . ;;'IQ ri�/i r;Xa }�y, ONTRACTOR (GNAT RE STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this day of � , 20C by. 14 art rc , who is personally known to me or who _has produced. DLFL - as identification. Gt�21 3yl 3514 �� Signature of Notary'm CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF The. foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced as identification. Signature of.Notary LU w C N ZON_ 0o�r Type or Print Name of Notary - W z Type of Print Name of Notary p¢< Notary Public 'Title mpX m } w Notary Public Title � m Commission Number `°° r Commission Number =,* (seal) (seal) NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. SECTION: TOWNSHIP: ZONING: C_ LAND USE: FLOOD ZONE: FIRM MAP #: l CST TYPE: OCCP TYPE: WATER: SEWER LOT OF REC (befr 1/90) LOT OF REC (aftr 1/90) DECAL LIBRARY NUMBER IMPACT FEE REPORT PUBLIC BLDG CODE IMPACT FEE ROAD GROSS ROAD IMPACT ZONE S�Q IMPACT FEE DUE SCHOOL• CREDIT IMPACT FEE POLICE FEE FIRE FEE Y N 4DDITIONAL SPECIFY: PERMITS READ REVIEWS ZONING ZONING PLANS ..REVIEWED BY EXAMINIP SATE :.OMPLETE ' NITIALS RANGE: MAP NO.: LOT CVG %: TAZ NO.: 1ST FLR ELV: MAX HGT: MAX. OCCP: # OF FLRS: SPRINKLERS STORMWATE R LOT SPLIT LOT SPLIT READ APPRV'D PARKS PERMIT IMPACT FEE FEE HABITABAL RADON FEE AREA Y N REDIT TOTAL ROAD IMPACT FEE N :?•.;•:;:l�;;�{.:_>•::;•:r:_•:•>:>: <: r •; srz :: TOTAL. -SCHOOL i {i:??:iiiiiiiiii:v�i::v:l g.::.;.::::.,::::::•::._::::::.. IMPACT FEE MISC FEES: TOTAL POLICEIFIREI MISC. FEES. TOTAL ALL FEES Q,I'VEOF TATION:SEA MANGROVE TURTLE "0A