HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` Permit Number: \11 t5- 01A `JI-
_;—: -:,w----- SCANNED RECEIVED
BUil�d' ng,13dirmit Application MAY 7 �p)g
Planning and Development Services ST. Lucie County, Porntitting
Building and Code Regulation Division -
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line era
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PROPOSED'IMPROVEMENT
LOCATION:
43a o Q-�la- Address:
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Legal Description: !L[J� 0
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Property Tax ID #: �" " lb OCR- O Lot No.
Site Plan Name: I (.l V i Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF VI/O'RK:' l _
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Additionalwork to be nertormed under tispermit-check all apply:
CIHVAC Gas Tank Gas Piping In Shutters Q Windows/Doors
_
5lectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ y q s • d C� Utilitiesftewer Septic Building Height:
OWNER LESSEE:, CONTRACTOR
Name LQ1 L 11S b(Iff IV I I Name: Micheal Flaxman
Address I Company: Energized Electric.
City: ate Address 4252 Bandy Blvd.
Zip Code: F x: CT. U ity; Fort Pierce State: FL
Phone No._ l 4 � 1.016 Zip Code: 34981 Fax: 772-318-6672
E-Mail Phone No. 772-466-1095
Fill in fee simple Title Holder on next page ( if diffe_rerrr--• I -Mail. Q1Y1�� C�;Jv
from the Owner listed above) I State or County License:����
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S.URPLEIVIENTAL 'ONSTRU LT, ,LIEN'':LAUU`'IN'FORIVIATIO`N:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
N a m e: Mlcheal Raman
Address:
Address:"
City: State:
City: Fort Pierce State:
Zip: Phone
Zip:' Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: 4252 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
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 recording our Notice of Commencement.
Signature of w er/ Less, a/Contractor as Agent for Owner
Signature C ntrac r/License Holder .
STATE OF FLORIDA
ORI A STATE OF FLn',,
COUNTY OF v`F" v�
COUNTY OF � Il �' 1p,cl
The instru ent—w,as�l �cknowledo efore me
thi da of J 20'! by
The InWstrumlmt was knowledg efore me
thif i C� 2Q by
Name of r n making statement
Personally Known OR Produced Identification
Name of p n making statement
Personally Known OR Produced Identification
Type of Identif'catio .\'
Ql
Produced LA
Type of Iden
MmaRLAVW \ n
CrProduced
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1 1:11,1
Lai: 11.1 1111111o"11111 .............. . ............. �j /-A/D
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Si n ture of Notary Public- State of Florida)
(Sin re of Notary Pu lic- State of Florida )
ission No. (Seal)
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Comm ssion No. �����`�FERliCi, (Seal) ,
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Rev. 8/2/17 101j°°
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