HomeMy WebLinkAboutApplication for Zoning Compliancevrt$
DATE FILED:
PLAN REVIEW FEE: O • v RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE u.FILLED IN TO BE ACCEPTED
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ST. LUCIE COUNTY PUBLIC WORKS
`o [� _4 BUILDING $ZONING DEPARTMENT
2300 VIRGINIA AVENUE
'20R10Q' FORT PIERCE, FL 3498275652•
772-462-1553
APPLICATION for BUILDING PERMITCERTIFICATE. of CAPACITY/ZONING COMPLIANCE
_PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: -��1j AY
2. S/D NAME: �phJ_e �._ SITE PLAN NAME: .
3. PROPERTY TAX ID #: I LA Z
4. LEGAL DESCRIPTION (attach extra sheets if necessary):. •�ciSK� �p ,$ (9 tll� I (,,p�- 1
5. PLAT. ICE 6. PAGE 7. BLOCK •8. LOT
BOOK I NO. -I NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. LOT DIMENSIONS �L( �{ K 12 4 el X I u X j 11,6.1
10. DESCRIPTION OF CONSTRUCTION`T ROJECT OR WORK ACTIVITY:
i 1. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT
SIDE SIDE:
t2. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ •j NEW CONSTRUCTION EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[9 RESIDENTIAL [ ] COMMERCIAL
[ j OTHER (SPECIFY) [ ] INDUSTRIAL .
13. DESCRIPTION OF PROPOSED USE:
14. Sq. Ft./CONSTRUCTION: I� S 5�. 15. Sq. Ft. 1st Floor.
16. CONSTRUCTION.- $ O �C�� . 5.9
The value of cdnstrucdon is used to determine the amount of permit fees to be assessed. St. Luae County reserves the right to question and/or modify the
indicated value of construction if it Is demonstrated that the submitted f1gures.are not ooitisistent with similar types of construction activities., If the value is $25W
or more, a RECORDED Notice of Commencement must be submitted with this application.
LCCDV Form No.: 001-02
IWNER INFORMATION:
c
G-
AME: E l a yY` i.a S6(% l in G• 'C \ Q Y
DDRESS: I ��►� C+.hr
ITY: S_CIA �f LV C Q STATE: �� ZIP J
`HONE (DAYTIME): (_ 1 5 5— 5 �;L5--)
THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
ELOW.
EE SIMPLE TITLEHOLDER: .
DDRESS:
ITY: STATE: ZIP
HONE (DAYTIME):
ATION
T. of FL REG.10ERT #:
U$INESS NAME:
UALIFIERS NAME:
DDRESS:
ITY:
HONE (DAYTIME): ( )
RCHIT/ENGINEER:
DDRESS:
ITY:
HONE (DAYTIME):
ONDING COMPANY:
DDRESS:
ITY:
ST. LUCIE COU
/ r
STATE:
FAX NO.
M
ZIP.
+' \ i QYC STATE: ZIP
STATE:
ZIP
ORTGAGE LENDER:
DDRESS:
ITY: _ STATE: ZIP
MPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days
fter 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, andto obtain a certificate of
rapacity, 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-
-esidential 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
YOOR 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.
DWNER'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.
RT CTOR S NA 'TURE
STATE OF FL ID
COUNTY OF CJ
STATE OF FLORIDA
COUNTY OF
The foregoing instrument wa��slIackno ledg�erdI Af.� The foregoing instrument was acknowledged
efore this day of (�T, 20 P, by before me this day of 20 , by
who is personaltV known to me or who
who is -personally known to me
has ced l� -as identification. or who has produced as identification.
ignature of Notary
V�4 CL_ t
Type or Print Narr
Notary Public
(seal)
VOTE:
Commis,
Signature of Notary
Type of Print Name of Notary
Notary Public Title
(seal)
Commission Number
TWO (2) SIGNATURES ARE REQUIPW.. 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.
SECTION:
(1
ply
TOWNSHIP:.
�
ZONING:
LAND USE:
FLOOD ZONE:
FIRM MAP ##:
CST TYPE:
OCCP TYPE:
WATER:
SEWER:
- LOT OF REC (befr 1/130)
LOT OF REC (aitr 1/90)
DECAL
LIBRARY
NUMBER
IMPACT FEE .
REPORT
PUBLIC BLDG
CODE
IMPACT FEE
1�•
ROAD
GROSS ROAD
IMPACT ZONE
`�]
IMPACT.FEE
DUE
Y.
SCHOOL- .
CRkDI
IMPACT FEE
POLICE FEE
FIRE FEE
Y
N
ADDITIONAL
SPECIFY:
PERMITS
REQ'D
REVIEWS
ZONING
ZONING
PLANS
REVIEWED BY
EXAMINI
DATE
COMPLETE
Q
Gl
INITIALS
IA
I
RANGE: MAP NO.: 1L
LOT CVG %: TAZ NO.:
1ST FLR ELV: MAX HGT:
7 (p,00
MAX. OCCP: # OF FLRS:
SPRINKLERS STORMWATE
R
LOT SPLIT LOT SPLIT
REQ'D APPRV'D
PARKS PERMIT .
IMPACT FEE FEE
HABIT RADON FEE
AREA
Y N
REDIT CTOTAL ROAD_
IMPACT FEE
TOTAL
} <>:;::»::v;;•:::•;.:: :.:: ;. IMP CT FEE
MISC FEES: TOTAL
POLICE/FIRE/
MISC.-FEES
TOTAL ALL
FEES
VEGETATION SEA
NG TURTLE
MANGROVE