HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOFFICE USE ONLY:
BP #: 65/2• a6
OFFICE .USE ONLY -
SECTION:
TOWNSHIP:
RANGE:
41
MAP NO.:
ZONING:
LAND USE:
LOT CVG %:
TAZ NO.:
FLOOD ZONE:
FIRM MAP
_ l V
1ST FLR ELV:
MAX HGT:
CST TYPE:
OCCP TYPE:
.
MAX. OCCP:
# OF FLRS:
WATER'
SEWER
SPRINKLERS
STORMWATE
R
LOT OF RED (befr 1l90)
LOT OF REC (afir I=)
LOT SPLIT
LOT SPLIT
REO'D
APPRV'D
1,.Iv-�
DECAL
LIBRARY
PARKS
PERMIT
NUMBER
IMPACT
IMPACT FEE
FEE
RED
Z
PUBLIC BLDG
-FEE
HABITABALE
RADON FEE
CODE
d<
IMPACT
AREA
(RADON)
ROAD
I l t� t
GROSS ROAD
C IT
Y
N
TOTAL ROAD
IMPACTZONE
1 `
IMPACT FEE
IMPACT FEE
UI
DUE
Y
N
SCHOOL
CREDIT
TOTAL
IMPACT FEE
SCHOOL
-
IMPACTFEE
POLICE FEE
FIRE FEE
MISC FEES:
TOTAL
POLICE/FIRE/
MISC. FEES -
Y
N
ADDITIONAL
SPECIFY.
TOTAL ALL
PERMITS
FEES
READ
REVIEWS
ZONING
ZONING
PLANS
VEGETATION
SEA
MANGROVE
REVIEWEDBY
-`EXAMINING
TURTLE
DATE
COMPLETME
a (0
3
INITIALS
�J
DATE FILED:
PLAN REVIEW FEE:
9
RECEIPT NO.:
PERMITNUMBER: �S/�' 4 66t
ALL INFO UST BE COMPLETE at FILLED IN TO BE ACCEPTED
�
t Gy ST. LUCIE COUNTY PUBLIC WORKS ¢(�, �� c'
BUILDING &ZONING DEPARTMENT 69_6L _ d$Z
2300 VIRGINIA AVENUE �' �/j,Q��'
OR10 FORT PIS � 1553 �__-=�e�/�
_APPLICATION for. BUILDING PERNHT
CERTIFICATE of CAPACITY/ZONING COWIPLIANCE
SCANNED
PROJECTINFORMATI BY
r 1icrwjQ -C , . St. Lucie County
LOCATION/SITE ADDRESS: (Y\ l I - —`5 J�l) `-0�� 3
2. SID NAME: _ D12(`IS _S/D SITE PLAN NAME:
3. PROPERTYTAXID#:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
Ll
5. PLAT 6. PAGE 7. BLOCK 8. LOT r�
BOOK_ NO. NO. NO. J
9. PARCEL SIZE: (ACR /SQ FT. �1 `�— LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK
�.-
11. SETBACKS (ACTUAL) FRONT: BACK:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION
[ ] RESIDENTIAL
j4'OTHER (SPECIFY)
[ ] EXPANSION/ADDITION
[ ] (RQMMERCIAL
CC)Arru.4 4 anc�( Sca
441
RIGHT
SIDE SIDE.
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
13. DESCRIPTION OF PROPOSED USE: _) i rn R \ P • nn. \`/
14. Sq. FL/CONSTRUCTION: 15. Sq. Ft. 1st Floor.
16. VALUE OF CONSTRUCTION: $S v ��I.So2�00
The value of construction is used to determine the amount of permit fees to be assessed. SL Lucie County reserves the right to gtresWn and/or modiy the
Indicated value of construction ff it Is demonstrated that the subndtled figures are not oonsistent with similar types of construction adivitier. if the value is S250C
or more. 2 RECORDED Notice of Carnmencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER
NAME:
INFORMATION:
ADDRESS: \�J 01'n &) Cam) Lot I e- l
CITY: S STATE: �7C__ ZIP
PHONE (DAYTIME): f I
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS
BELOW.
EE SIM'�F �_� OLDER '
ADDAESE:
STATE: ZIP
PHONE (DAYTIME): ( I
Ld CTOR INFORMATION
'ST' dF=REGJC—ERT--f; CST LUCIE-COUNTY-corril
USINsF,S$_piA E '
('QUALIFIERS NAB _
ADD /;tpf J LT K r
PNO MA ,: :4Vi foci—��gca - -77a-991—l(491l
ARCNITIENGINEEP-
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
; nrwy ;erce STATE: lam_. aP �J
STATE
Crtv: STATE
23P
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, 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.
• ,O NER/C NTRACTOR SIGNATURE
STATE OF FLO A
COUNTY OFL tg�A-)
The foregoing instrument was acknow,Iedged
before me this day of a!*--20Qj by_-�anid
G , who is personally known to n or,
SignatUF .- JOhdry Eileen M. Gorman
.. nr- MYCOMMISSION# DD010148 D(BIRES
I April 22, 2005
BONDED MRO TROY FAIN INSURANCE• INC
Type or Print Name of Notary
Commission Number
CONTRACTORSIGNATURE
STATE OF FLORIDA
COUNTY OF Ma-r�-iIU
The foregoing Jnivament i
before me this W day of
44i C14 0 t 16- 1 ANdo is n
or veto hap produced
ignature of otary
Type of Pri t Name of Notary
Notary Public Title
l70AS(P ommission Number
)by
me
(seal) (seal) Q'00 Sally Fora
My Commission DD2%M
an Expires April Os, 2008
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. f
IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAK
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
I