HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 1 RLMVED AUG 0 4 2011Permit Number: I161-0 q
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
OPdSED I ROU MENT
Address:
Legal Description: =79c�c - (L� y r Es eS �_ -�' o3-&Y, IS L-D-, I CmRP 3N
Property Tax ID #::39y2- (ooL1' 003L1— OcDCO—a- Lot No.
Site Plan Name: Block No. I S
Project Name: 0—nk 1 Dal i-5
Setbacks Front Back: Right Side: Left Side:
h ETAIi IMD DESCRIPTION OF WORK;
iaitionai worK to 4je
�HVAC
Electric
nerrormea
L
unaer tnis permit— cnecK an
Gas Tank ❑Gas Piping _
Plumbing Sprinklers
apply:
Shutters ❑ Windows/Doors
Generator Roof
_1
0
Total Sq. Ft of Construction:
00
Cost of Construction: $ zc
S Ft. of First Floor: _
Utilities:nSewer 0 Septic
Building Height:
O NERfESS;EE:- -
�®NT AT
Name'
Address: N IOL go_su 5�-.
City: F� Pie.r�. I� 'State:
Zip Code: 3L(0182 Fax:
Phone No. `1-12" 22LA, 02.36
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.
SDI PPE ,ENT L CONSiR0-A-L-N LtEN'I W fNFORMATI:O'N:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
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
LU11111WFILIFIX WUf K U1 [ULUIUMM VUUI IVULILC UI UUfrlfrlCflLCfrICr1L.
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_ Signature of Ow see/Agent Signature of Contractdr cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5+ (-t kc�P_ I COUNTY OF
The fo��ing instrument was acknowledged before me
this 3 day of 20 11 by
Robert Zralick 1
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced .-sr, AAWia R
The forgoing instrument was acknowledged before me
this 3'4 day of PmAn LA V 20 1-1 by
Robert Zrallack
(Name of person acknowledging)
(Signature of Notary Public- tate of Florida )
Personally Knowny OR Produced Identification
Type of Identification Produced ..V . Merie Samb Miialr.
NOTARY PUBLIC NOTARY PUBLIC
Commission No. 9 Ion 137 STATE OF FLORI ACommission No. rFGIdl37 S aTATE OF FLOR;i., A
Comm# FF912137 Comm# FF9121;..'
Revised 07/15/2014
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