HomeMy WebLinkAboutZrallack permit _000359All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building. Permit Application
Planning and'DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (7721,) 462-1578
Address:
Commercial
Residential ✓
Property Tax lD #: 140")- "l -52 - (Y) Z S - l-C6 '6 Lot No.
Site Plan Name: Block No.
Project Name: -Zfc- � ��
DETAILED DESCRIPTION OF WORK: to 16 �I ��,���� L1<-Itl ail- 1.t%
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
✓Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing — Sprinklers ^ Generator __,_ Roof Pitch
Total.Sq. Ft of Construction:
Cost of Construction: $ 7
Sq. Ft. of First'Floor: —
Utilities: —Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameT7YL4e-1 - Zra.116A<--
Address: 53225 �S-Thl .
City: \`Li%fC4,e State: (�A-
Zip eodL
Phone No.
Name:Z>»v S JLCr 14,
Company:
Address:
,
City:
Zip Code: F�,
Phone No % k'S/q_3
stateC�
Fax:
,
E-Mail:
Fill in fee simple Title Holder orb next page ( if different
from the Owner listed above)
E-Mail L�
State or e0unty License KAq/-
0 57 9,R5
if value of construction is 2soo or more, a. KEGUKUtU Notice of Commencement 15 requireu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR A : Application is nereoy
l certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structture. Please consult withpyour Home Owners Owners
ation iandrreview your deed for any restrictions which which maor
apply obit such
in consideration of the granting of this requested permit, 1 do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St- Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property: A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
..�L .. i..rlincr ainr Kintiro of (nmmPnr:PmP_nt.
Witty lenaeroran aLLurrm i utz atvl+<<+ctw
- - --
Signature f- ssee/Contractor as Agent for Owner
Signa tractor/I =tense Holder
STATE OF FLORI
STATE OF FLORIDA
COUNTY OF
COUNTY OF S4- Wci,e
Swgtn to {or affirmed} and subscribed before me of
Sworn to (or affirmed) and subscribed before m[nr-
P Pr or Online Notarizo
adayofS�in�P_
Physical Presence or Online Notarization.
�/ ysicaI ence
20� by
this _day of ()/� ; 2(
"0M
Name of person maki statement.
Name of erson making itement.
pEkeny
_j1
_OR Identificat-ion
Personalty Known �OR Produced Identi
Edentification
Known Produced
Type of identificationdProduced
re of Notary Public- State of Florida }
ignature of Notary Public- State of Florida•�..
ommsion No.G�3-- (seal}
Commission No. ir��__ (Seal)
fttyi>=y�rs
FRONT 20mimr- SUPERVISOR
REVIEW
PLANS VEGETATION
REVIEW REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/b/zu
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
772-462-1553
FAX 772-462-1578
AUTHOkMTION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie Counly
RE: Y-
Permit #
Credit Card Users: 1 1.5010 Surcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
✓ VISA
MASTERCARD
Credit Card Number
Expiration Date Zip Code ��i-&J-q
3 digit security code &05
Amount $ + 1.5% surcharge
Business Name:
Authorized Signal
Print Name: UJ�
Phone: (_—) XZLF- -51 LJ-3
Fax: (-D-'P)-k7e
Comments:
SLCPDSD Revised 4/01/2P10 EN