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Home My WebLink AboutApplication for Zoning Compliancef0� DATE FILED: —3 - 0 PLAN REVIEW FEE: ) SU RECEIPT NO.: _yZ- PERMIT NUMBER: �IoO3 CONCURRENCY FEE: ZS RECEIPT NO.: CERT. CAP. NO.: , ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED c�E o St. Lucie County Building and Zoning 2300 Virginia Avenue 'r�OR10Q • Ft. Pierce, FL 34982-5652 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: :,A 171 Nf,-Hl >oS Jql ✓d 2. SAD NAME: /U& �z'S T SI&4,g d SITE PLAN NAME: 3. PROPERTY TAX ID #: 5 o / - 011 y— 000 / 4. LEGAL DESCRIPTION (attach extra sheets if necessary): LEWes _U (� QarA Tom" . H dQ S e in s 5. LAT t t BOOK � c) � 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE: ACRES/SQ FT. 91qq.00LOTDIMENSIONS 10. DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: r—oundc�^ 11. SETBACKS (ACTUAL) FRONT: BACK: , RIGHT: LEFT: ' • D SIDE SIDE $-a I '30 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED U roL1 vh c1cL bv", r YY1 U Jv A t' (-�o YM V� LX�Y l 14. Sq. Ft./CONSTRUCTION: 15. Sq. Ft. 1st Floor: 16. VALUE OF CONSTRUCTION: $ q / 3 0 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 j� OWNER INFORMATION NAME: D ;• of R A P-0 W y1 ADDRESS: a171 Ntj+l-eS TS io•v+8 13lyA CITY: �� e n Q �� STATE: �L ZIP �� s � PHONE (DAYTIME): (77a) 8031 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: 0. b cy-e ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): CONTRACTOR INFORMATION ST. of FL_REd.k]ERT #: C GC - D / 5 5 ST. LUCIE COUNTY CERT BUSINESS NAME: De v.`rr i e %� Al ec J C�n-s -� • Ca QUALIFIERS NAME: ,Ue n vi t e /U e ADDRESS: -�L75-7 ME Cale S,or- nz QR- CITY: �e�n s �_.� 6-eaLj STATE: P L ZIP 3 Lf 9 S PHONE (DAYTIME): FAX. NO. email: ARCHIT/ENGINEER: :F-0 C ADDRESS: /5-D 1 D-ec. keg 1/� l/�i i �- 419 CITY: SVva0-4 STATE:` FL ZIP 24N99/' PHONE (DAYTIME): (9 ) a8 / ` 7( 4/-( BONDING COMPANY: 6/4 ` 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,ofall 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. OW ER'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 constructi and zoning. OWNER/CONTRACTOR SIGNA RE C NTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF MP02 A,r-� CpallX!t? The foregoing instrument was acknowledged before ^ me this �'l day of k, 20,, by _4Pq irA — , who is personally known to me or who has produced 1Q 2,13 g,.-�� VC!�, as identification. Signature of Notary "Co �r Type or Print Name of Notary NOTARY PUBLIC -STATE OF FLORIDA ATE STATE OF FLORIDA Karla Surma it" ywCommission �DD3918UNTY OF M:\�n Er'pires: FEB. 01, 20,9 aX_.he foregoing instrument was acknowledged before me this '7_`% day of 2b , 20ag by KpalA -,Lx; 7n_ , who is personally known to me or who has produced as identification. Cr�a„ Signature of Notary gcze\R Type or Print Name of Notary NOTARY PUBLIC SZ•\TE OF FWA NO PUBLIC•SZATEOFenCommis K�, Comm on v..ai`m Commission � DD391809 Commission # DD391809 Expires: FEB. 01 200 NOTE:B� i�,A-REQUIRED. EACH SIGNATURE MUS ��ng LYING FOR ' THIS BUILING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPPEAR� TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION. For specific instructions see appropriate permit checklist. ,y2 ! iC Ap a �� ` SECTION TOWNSHIP RANGE MAP NO. ZONING � LAND USE n � LOT CVG % L2 1 451 TAZ NO. FLOOD ZONE FIRM MAP # 1sT�FLR ELV MAX HGT . . OU CONST TYPE � OCCUP TYPE n � MAX OCCUP # OF FLRS WATER SEWER SPRIol NKLERS STORMWATER LOT OF REC LOT OF REC (after LOT SPLIT LOT SPLIT before 1/90) 1/90 REQUIRED APPROVED ml, ADMINST LIBRARY PARKS PERMIT VARIANCE' � IMPACT FEE IMPACT FEE FEE REPORT PUBLIC BLD RADON FEE CODE IMPACTFEE H�ABITABL EA ON) SCHOOL S S` Q GROSS ROAD CREDIT Y N - •TOTAL ROAD IMPACT FEE