HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE UONLY
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TOWNSHIP
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RANGE
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ZONING
LAND USE
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LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
IsT FLR ELV
CONST TYPE
OCCUP TYPE
P
# OF FLRS
WATER
SEWE
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC (after
LOT SPLIT
LOT SPLIT
(before 1/90)
1/90)
REQUIRED
APPROVED
ADMINST
LIBRARY
PARKS
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLD
HABITABLE
RADON FEE
CODE
IMPACT FEE
AREA
(RADON)
SCHOOL
GROSS ROAD
CREDIT
Y
N
OTAL ROAD
IMPACT FEE
IMPACT FEE
IMPACT FEE
DUE
SCHOOL
CREDIT
Y
N
TOTAL
IMPACT FEE
=...�
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL
Y
N
SPECIFY
TOTAL
PERMITS
of ALL
REQUIRED
FEES
REVIEWS
ZONING
ZONING
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMING
DATE
COMPLETE
INITIALS
DATE FILED: 6-1 �:[ -63-
PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: �� �' C)a q
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
St. Lucie County .Building and�Zfmi3rg -
2300 Virginia Avenue — } %,�
J ORtO Ft. Pierce, FL 34982-565;
JYI I C/S 772-462-1553
5
APPLICATION for BUIL'- DING�PI�RMIT
CERTIFICATE of CAPACITY/ZONING--COaP�L�{IA G '
iA.
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: G J0o N l r(ql n l a kfnue
2. S/D NAME: SITE PLAN NAME: 81. L Ad m'wi }
3. PROPERTY TAX ID #: A I L aD4 - O-+=-O-0M
4. LEGAL DESCRIPTION (attach extra sheets if necessary): � A4inc-V\e)c�
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: CRES Q FT. Z4 --5U LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: l Or rtnoy lil oy-)
c r con ccunsc tv ,� rx if-Z tee%
11. SETBACKS (ACTUAL) FRONT: BACK: N RIGHT: LEFT-
�A �A SIDE N/� SIDE 'VA
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: C0-
j,
14. Sq. Ft./CONSTRUCTION: l 2 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: $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
UP
4., 1 ye
L1..
CERTIFICATION:
OWNER INFORMATION
NAME: S+- b A 6 e Qpuy*
ADDRESS: 2300y i'fgl ni G le
CITY: rcYSTATE: I ZIP q�Z
PHONE (DAYTIME): i�4J:AU2- 140Q dr Aly2.1� emaiLr 'Vlynn
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:
PHONE (DAYTIME): �)
CONTRACTOR INFORMATION
ZIP
ST. of FL REG./CERT #: ST. LUCIE COUNTY CERT #:
BUSINESS NAME.- C)u'3 r1 y-
QUALIFIERS NAME:
ADDRESS:
CITY -
PHONE (DAYTIME):
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): L
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
FAX NO.
STATE:
STATE:
STATE:
ZIP
email:
ZIP
ZIP
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.
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 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.
The foregoing instrument was acknowledged
before me this 11--k day of PN�,n� 200*by
Cx,�(N who is personally
1k��wh has o roduced
as identification.
Signature of Notary
Type or Print Name of Notary
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
C' 0 8
The foregoing instrument was acknowledged
o z a
before me this _ day of , 20_, by
e z
, who is personally
M c e
known to me or who has produced
8 CLE
as identification.
� m
v,,,
G ro
°i
Signature of Notary
.; V
Type or Print Name of Notary
Commission No. (Seal) 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.
I