HomeMy WebLinkAboutBuilding Permit Applicationv 4
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
• RECEIVED 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
PROPOSED IMPROVEMENT LOCATION: I
Address: 32(00 La.Keshoce'Dr. \AuNC,h;1,son 151anA FL 349LA9
Legal Description: W_'Shor8_ S�nciS �lo�to' 1�"11�llali� �� ��� 383cj�1 ii-l�
Property Tax ID #: 14d5 ~ (a_7(0- oof g" 000` + Lot No.
Site Plan Name:
Project Name: --s-
- eca` C �
Setbacks Front Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK: I
SOCA(2 (13(3L. IK'��r—� S�S+et�
CONSTRUCTION INFORMATION:
Additional work to e performed under this permit- check a apply:
E]HVAC0 Gas Tank Gas Piping _ Shutters a Windows/Doors
11 Electric Plumbing Sprinklers F]Generator E]Roof
Total Sq. Ft of Construction:
0
Cost of Construction: $ 3, / 44
S Ft. of First Floor: _
Utilities: Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: RobertZrallack
Address: 52(oo Lo_Ka Share_ 'DC.
Company: Solar Energy Systems
Address: 160 Smallwood Avenue
City: 4LA6) i n Son .:Y' S � i-CV-4 State: F —
City: Fort Pierce State: FI
Zip Code: 3 NgI LQ q Fax:
Phone No. g5-K-32:5- ei%OI
Zip Code: 34982 Fax: 772-466-7937
E-Mail:
Phone No. 772-464-2663
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 S
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
`f�- n
����7c„
��R1M�ATl
�
Ia
; w . a
�NS
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
commencing worK or recorcling your Notice or Commencement.
s
_ Signature of Owner ee/Agent Signature of Contracto icense Holder
STATE OF FLORIDA STATE OF FLORIDA-
COUNTY OF �5L- L.iue COUNTY OF fAt CA -LC
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this33 day of Au 9 us+ 201Zby this 3 day of (AuA(,k7>+ 20 LZ by
Robert Zrallck 1 Robert Zrallack
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida) Si ature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced— �uzr.� Marie Sarah Mus1c Type of Identification Produced_ _ MadeSe.
NOTARY PUBLIC
Commission No. 6r9rzl3-7Va.STATE OF FLORI ,commission No.
Comm# FF912137
Revised 07/15/2014
NOTARY PUBLIC
8E OF FLORIDA
Comm# FF912137
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS