HomeMy WebLinkAboutApplication for Zoning ComplianceOFFICE USE ONLY
BY #:
MAP NO.
TAZ NO.
SECTION
32
TOWNSHIP
RANGE
ZONING
'PLC
LAND USE
FIRM MAP 4
OCCUP TYPE
SEWER
LOT OF REC
After 1/1990
LOT CVG %
i ST FLR ELv
MAX OCCUP
SPRINKLERS
LOT SPLIT
REQUIRED
FLOOD ZONE
7
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MAXHGT
�M HGT
CONST TYPE
WATER
# OF FLRS
S
STORMWATER
LOT OF REC
Before 111990
LOT SPLIT
APPROVED
REPORT HABITABLE
CODE , AREA ON PER MT
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IMPACT
PUBLIC BI D
IMPACT FEE
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IMPACT
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GENERAL
SCHOOL
IMPACT
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FEE
FEE
FIRE/EMS
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N
DRIVEWAY
FEE
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SPECIFY
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PLUMBING
LOT OF
RECORDREQUIRED
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DATE SENT TO ADDRESSING:.
REVIEWS; _r:",FR6NT. ZONING SUPERVISOR PLANS
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OFFICE USE ONLY:
DATE FILED:
PLAN REVIEW FEE: -rlx- RECEIPT NO.: PERMIT NUMBER:
CONCURRENCYFEE: )wC. U U - RECEIPT NO.: CERT. CAP. NO.:
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ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Te
Ft. Pierce, FL 34982-5652
r C/
4_ 772462-1553 A
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APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: 50 3 2 WA TER-5 PtV& WA Y, FoRr P1 =/Zd g5, Fl- 3 J-/ 9 V cl
,2. PROJECT NAME: SITE PLAN NAME: WA-MRSOAI&
3, PROPERTY TAX 11) #:
4. LEGAL -'DESCRIPTION (attach extra sheets if necessary)- W.4-rEE,10,.5&/y<S P U D PL. A7-
NO, OAIF- CP5 qZ-3'0 JOT IZ'COR Z21
5, PLAT BOOK -Y 6. PAGE NO. .3q 7. BLOCK NO. 8. LOT NO. -72-
9- PARCEL SIZE(ACRESISQ FT.);.-0 12 44 A_F_ LOT DIMENSIONS: 1-2
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 41 cA1.57A OC-7-1
-SETBACKS (ACTUAL) FRONT: je> BACK: 'fY0 RIGHT SIDE: LEFT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
N"NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION
jyr RESIDENTIAL COMMERCIAL INDUSTRIAL
OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: _01*4 LE
14. SQ. FTOF CONSTRUCTION: :5'SJ2 15. SF. FT I stFLOOR.
16. VALUE OF CONSTRUCTION: S
The value of construction is used to determine the amount of peimit 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
UPDATED 6/25/09
OWNER INFORMATION
ADDRESS: SGIO I-1AR80I_5L,4WD 11 Ay
CITY: J U P I I`E R STATE:'FL ZIP: 73 '-:!, 1/ S S.
PHONE (DAYTIME): �6
�b . I q % - -7 -Z 4 `7 Email: P®iYNA lrC R C- -9-5 C-D e ®,eti►�.57,'9 ty,=
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THB'OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIIMIE): (__)
STATE:
trg
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: C R C_ 1 01 Co q?� ST. LUCIE COUNTY CERT #: Z 7 d G 3
BUSINESS NAME: C>CR 011, T
QUALIFIERS NAME: _ MA R 10 AIS 8 Ue- C I
ADDRESS: 2 Sc_ Dl X 115 N `kV Y
CITY: .S 7'U A A-7— STATE: ZIp: 9 y J
PHONE (DAYTRvffi): = 2 19 - 2 f SO FAX NO. `2'aS 2 O _Z!y Email: MAR 1 p
ARCHIT/ENGINEER %41i/ Am G'aeP ,/ 41m 131J' S a,611 .!5 F_
ADDRESS: i I, /Co S VI/ i
CITY: 50C,4 RAT-O,..i
PHONE (DAYTRv1E): (fin dam% Z 3%19 1
BONDING COMPANY:
ADDRESS: _
CITY:
MORTGAGE LENDER:.
ADDRESS:
CITY:
v
STATE: ap:
STATE:
STATE:
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.
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, FENCES; ETC.; not otherwise included with this building permit. application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is, in conflict with any applicable Homeowner Association rules, bylaws or any- covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's`Association and review your deed for any restrictions which may apply.
.s
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: YOUR FAILURE TO RECORD A NOTICE -OF 'COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
SIGNATURE
STATE OF FLORIDA
COUNTY OF M AtZ•]� III
The foregoing instrument was acknowledged before
me this 1 'S day of ZgC_eM_ "20_� 1
by 1411�& A-)V '9 r2 sS
who is personally known -X— or has produced
C rRA x SIGNATURE
STATE OF FLORIDA
COUNTY OF A R'f i�
The foregoing instrument was acknowledged before
me this l'S day of `eM))t4 , 2011 ,
/
by /" MAID )�rbu o
who is personally known X_ or has produced
as identification, as identification.
Signature of Notary Signature'of Notary
PA`fRICIAL-ASKREN
Commission N �S'39+�►� ; q. s eai) PATRICIA L ASKREN Commission No =' oMM(SStJ&W)4M94
MY COMMISSION # DD 945394, EXPIRES: January 9, 2014
EXPIRES: January 9, 2014 )g ) '. •• dC`
�Bonded Thru Notary Public Underwriters
Bonded Thru Notary Public Underwriters 1 / `� R `. ry
NOTE: + +; t M. 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.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.