HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECER ED AUG 04 2017
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
PIMP, O.SED IMPROU�E, T LOCIAT1®N. Y
Address: -IgoZ7
P10_r1+6t- 4_on La
Kes 'D(-. PL a Ukc� e, R_
3L(g76
Legal Description:
&.seCVe
Phase IL- LoT 48j6239SS-62S;46
13- jqg k-
PropertyTax ID #: 33a(- :90I-- OOLf$- 000- a Lot No. 4$
Site Plan Name: Block No.
Project Name: YiaF1�� r12.o--C-�rl �i sS
Setbacks Front Back: Right Side: Left Side:
20(Ae, 1?OOL. Ne chi n� S-L
_)54Exy`
iditional work to be�jertormea unaer tnis permit— ci
11HVAC L_I Gas Tank ❑Gas Piping
Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
a
Cost of Construction: $ !or -713. o40c
all apply:
_ Shutters
❑ Generator
Sq.
of First Floor: _
Utilities: L_ISewer 0Septic
QWindows/Doors
Roof
Building Height:
OWN' W%I' 5`SEE:
CONTRACT®R:IN 1111,
Name T l0E%ye c irv2. R-o t cS
Name: Robert Zrallack
Company: Solar Energy Systems
Address:-1CQi-1 elo_r4aA�,or, Lis Or •
City: 0- St k M rye State: EL,
Zip Code: 4ci SU Fax:
Phone No. '� $In' �� 910c)
Address: 160 Smallwood Avenue
City: Fort Pierce State: FI
Zip Code: 34982 Fax: 772-466-7937
Phone No. 772-464-2663
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: vpsolarenergy@yahoo.com
State or County -License: CVC056637 / 9057
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SU!PPLEIVIENTA C®NSTRUCTI®N LIEN° ��1W INFO,RMATI®N:'
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
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
commenclnE worK or recoraing vour Notice oT Lommencement.
r-
_ Signature of Own essee/Agent (Signature of Contra to /License
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St U__xC ie_ I COUNTY OF SL U,,c� Z_
The forging instrument was acknowledged before me
this 3g day of eaAquS - 20 Eby
Robert Zrallck 1
(Name of person acknowledging)
The forgoing instrument was acknowledged before me
this �' day ofR� Us% 20 I-7 by
Robert Zrallack
(Name of person acknowledging )
(Sig ihatur� a of Notary Public- State of Florida) (Sign ture of Notary Public- State of Florida )
Personally Known_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Marie Sarah Music Type of Identification Produced MarioSaT51T vus
NOTARY PUBLIC
Commission No. 'N'�I 1Z13� STATE OF FLORIE ACommission No.
Irr,1Z/37 §TATE OF FLORIDA
Canm# FF912137 omm# FF912137
------- ,....... 1 1 Exnlres8/24/2nlQ
Revised 07/15/2014
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