HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater � Permit Number:
1AINNFE�
RECEIVED---
Building rmit Application -MAY 10 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie county, Permitting
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 ling
Address: 01
Legal Description:
Property Tax ID #: C9,4gy-
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: I Left Side:
D`ETAILEPTI _D' QES,CRION OF VUO;Rk
S�
Aditional work to be nertormed . under tnis permit - cnecK
E1HVAC _ Gas Tank ❑Gas Piping
Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:������//��,,
Cost of Construction: $
LJ Shutters
Generator
S '. Ft. of of First Floor: _
Utilities: oSewer Septic
i
Lot No.
Block No.
QWindows/Doors.
0 Roof Roof pitch
Building Height:
Q.WN ER`%LESSEE
_'
,CONTRACTORti
Name
Name: Micheal Flaxman
Address::
Company: Energized Electric,;
City: Jf T(_'�.
Stated
Address• 4252 Bandy Blvd:
Zip Code t"'(� :Fax
p
p- �Q �D��
y: Fort Pierce FL
City: State:
Phone No. o?- �t O'�IJ
Zip Code: 34981 ::. Fax: 772-318-6672
hone No. 772-466-1095
E-Mail:
/�n`�
g,� . J ,l'nG1 ..tJ
Fill in fe -simple Title Holder
on..next•'page ( if different
E'Mail: Jennifer.energized
State or Count License: r� o
Y
from the Owner listed above )}.;� -,:.
,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
SUFPLEIVIENTA_L' 0*sS`UCTIQ`N91LIEN,`L�►VU'INFOR'NIATION;
s
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: "
lNamp:MlchealRaxman
'Add P 5:
ief State:
Address:
City: State:
Zip: Phone
ZI IMF Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Add ress: a252 sandy 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 ppermit holder to build,the subject structure
is in Home Owners Association bylaws
which conflict with any applicable rules, 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 recordi our Notice of Commencement.
• V�
Signature of 0 er Les a/Contractor as Agent for Owner
Signature, o ontractor/L cense Holder -
STATE OF FLORID �,����11 I�
COUNTY OF !i1/��
STATE OF FLORID
COUNTY OF �--u
The J"astrume t a k owle before me
this �f 2 by
The fo I instru a as ac Howled before me
this day of 29� by
1��-i I ' -ea I _F[u ' l�
� `e t I m r�
Name of persigfi' making statement
�"
Name of f�erf on making statement
Personally Known OR Produced Identification
Personally Known X OR Produced Identification
Type of Ident•fi tin / 'n ' I `^
1 � � own
Type of Identification
Produced soriov 44r)- �I
Produce N
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ig to of Notary Public- State of Florida)
Vgnture of Notary Public- State of Florida )
Com Sion NP. (Seal)
Commission No. (Seal) ..
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