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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: I ! - 0L ® 7
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 4496(o &c I& Foc'C7L 3`-AGs 1
Legal Description: ou t) rya Q �rtieS S I7 - PhaSe� $- !� i ZZ3{MRP t3� t3 N� f!o 2 7�31- 9d3�_ _
PropertyTax ID #: Lot No. 2Z3
Site Plan Name: Block No.
Project Name: '�>0r\0_kd Y-\OcF i4i
Setbacks Front Back: Right Side: Left Side:
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11HVAC
Electric
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Gas Tank ❑Gas Piping In
Plumbing Sprinklers ❑
apply:
Shutters ❑ Windows/Doors
Generator Roof
❑
Total Sq. Ft of Construction:
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Cost of Construction: $
S.Ft. of First Floor: _
Utilities: L_J Sewer []Septic
Building Height:
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C®NTRACTOR� F
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Name 'ior Gcu Y'-'GL
Address: 44901O dE;u1.Q De.
City: [ o>A- P-,P�C.2 State:'c L
Zip Code: 3" �q s 1 Fax:
Phone No. -7'72- L40-)A- ZNOq
Name: Robert Zrallack
Company: Solar Energy Systems
Address: 160 Smallwood Avenue
City: Fort Pierce State. FI
Zip Code: 34982 Fax: 772-466-7937
Phone No. 772-464-2663
E-Mail: vpsolarenergy@yahoo.com
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CVC056637 / 9057
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
s R�L M . 1. aN5 RU iION LIEN . iN o*�yR�', rT10"A
E�
DESIGNER/ENGINEER:
Name:
Address:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I 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, walls, 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 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 lender or an attorney before
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_ Signature of Own ssee/Agent Signature of Contra License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this L day of _D + be! , 20 IZby
Robert Zrallck 1
(Name of person acknowledging)
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this V� day of e2� , 20 11 by
Robert Zrallack
(Name of person acknowledging)
W/o2i_D
(Signature of Notary Public- State of Florida) (Sfgnature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced ,AWA2. Maria Sarah Music
Commission No.
Revised 07/ 15/2014
*TATE OF FLORI
Comm# FF912137
Personally Known ✓ OR Produced Identification
Type of Identification Produced Marie Sarah Music
NOTARY PUBLIC
Commission No. --1)213? a 'WE OF FLORIDA
Cantu# FF912137
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