HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DateMia'\_\k Permit Number:
• s - - RECEIVED
Building Permit Applicati n . APR 1% 2018
Planning and Development Services
Building and Code Regulation Division LST. Lucie Count
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 67
PROPOSED' LM�PKOVEMENT.LO.CATI,ON�e
Address:1a_+'::1t4 n� DA—, "PO -)
Legal Description: G(bC)U r 1 `� >a faC
Property Tax ID #:
Site Plan Name!
Project Name:
Setbacks Front
Back: Right Side: Left Side:
DETAILED; DES.CRI'FTI'O.N,, OF WORK':
tt on
cy�0to,r'i k��" jp� pai CID h
Lot No._
Block No.
CONS TRUCTI'QIVitINFORIVIATION:
_ - - --
itiona wor k to - e e orme under this permit — c ec a apply:
CIHVAC L�`Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing OSprinklers F]Generator F Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $� Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE::
CONiTRACTOR:'
Name
Cr \
Name: Micheal Flaxman
Company: Energized Electric
Addres G
City: �11 Stag �
Address: 4252 Bandy.Blvd.
Zip Code: `-,t ax:.
City: Fort Pierce State: FL
Phone No.1 � `'_7 o 5 --
Zip Code: 34981 .:' ,' Fax: 772-318-6672
Phone No. 772-466-1b05
E-Mail:
Fill in fee simple Title. Holder on next.`page;( if different
E-Mail: lennifer.energized@gmail.com
State or Co u nty.Lice rise: '
from the Owner listed" bove) •
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.'
SUPPLEMENTAL'CQNSTRUCTION?i''IEN LA1N'INF011IVIATIO'N:•
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not'Applicable
Name:
N a m e: Micheal Flaxman
Address:
Address:
City: State:
City: FortPierce State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Add ress: az5z Bandy Blvd.
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
is in Home Owners
which conflict with any applicable 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 recording our Notice of Commencement.
Signature of Owne La's -see/ ontractor as Agent for Owner
Signature of Q6ntKactorXCense,Holder
µ
STATE OF FLORID ..
STATE OF'`FLORI+
COUNTY OF ---t�L�l
WUN OF
The r of stru a was ackn wledg� efore me
this a of 0 bfy
g� efore me
The ^ay
this 0 byName
of pe on making statement
Nent
Personally Known OR Produced Identifl tion
Personally Known OR Produced Id ntification
Type of Identificati ` (
Type of Identifica 'on
ProdAcear\1-P1V A\ l
Produced
Si at e o Notary Pub Ic- State of Florida)
( gnatu a Notary Publi State o Florida )
Co mis on No. (Seal)
C mmissi n No. (Seal)
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DATE
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NOTARY
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RECEIVED
PC
13 L I C
DATE
COMPLETED
Rev.8/2/17