HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
- �Ew.:�LiJam= _ BY RECEIVED
Building Permit Application MAY 2 3 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
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P' bPOSED IMPROVEMENT LOCATION
Address: 1 Ei i /(�i 1, II /11
Legal Description: pl)a4e Q () (JDU1.t' w �tul-b __F_Gt0+1es
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Property Tax ID#:
Site Plan Name: n Q NG
Project Name:
Setbacks . Front Back: Right Side: Left Side:
Lot No.
Block No.
OETAILED:,;DESCRI'PTIO:N OF'1NO.RK:
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GO NSTRUCTI'O N,� INFO RMATI
ON;:. -ON;:. -
Additional work to - e e . orme - under this permit - check all apply: -
❑HVAC Gas Tank Gas Piping S tters ❑ Windows/Doors
Electric 0 Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: i S . Ft. of First Floor:
Cost of Construction: $ `Q Utilities: — Sewer Septic Building Height:
OWNER/LESSEE., r,
GONTRACTQR:.
Name w
Name: Micheal Flaxman
Company: Energized: Electric
Address:I -
�� n
City: TLI�I" Y-�I�r� ^�1 )(�Stateai L
Zip Code: 3tq—J i Fax:. (O( �-' U togE)'
Phone No.�� —rt 10,0"1
E-Mail:
Fill in fe simple Title Holder on next page ( if different
from the Owner listed above)
i
Address: 4252 Bandy, Blvd.
City: Fort Pierce State: FL
Zip Code: 34981 Fax: 772-318-6672
o e No. 772-466-1095
E-Mail:
/Q
State or County License: �-t 2w Qr �
d
IIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required. I
ShJPP:LEMENsTA:LrCf= NS�TR,UCTI®'N!'LtEN;`L
DESIGNER/ENGINEER: _ Not Applica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: 4252 Bandy Blvd. i
City:
Zip: Phone:
IINFOR<IVIAry 40'N.
MORTGAGE COMPANY: - Not Applicable
'N a m e: Mlcheal Raman
Address:
`Clay. FortPlerce State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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.
i. �
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 your Notice of Commencement.
Signature o.,VOvllner X6ssee/Contractor as Agent for Owner
STATE OF FLORI/D 1 /�
COUNTY OF ��--�,1�� `
Thc�
Iinstrumelht s ac<nowled efore me
this (L rday of M 20`by
L 0, �-ii Y (�.-X.-r' I
Name of p son making statement
Personally Know� OR Produced Identification
Type of Id�tj'�,I tiQ� r I LA
� I/ ,,, ^ /�
Produced I�GYSU WO .`A....K--�W w ► 1
2.0
Signature of o racto License Holder
STATE OF FLORID II
COUNTY OF _' L - d --( il�
The fo ��pjii}� instrum n as acknowledge fore me
this; Tft of 20 y
k__� f OkYMOJ'�
Name of pers n making statement
Personally Known - OR Produced Identification
Type of IdWiffl
%n�1Produced 6KL� GW`)
(Si nat re of Notary ffubliji S"QURdYri&a (Slgr(a ure of Notary rr'6 r; g f*'�.
N0TAq m.2
Commission No. ' P U ®L I C (Spal)'` Commission No. = 0.. ,® �Sea,f
PUBLIC,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO.N���i� ���'.....MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW R'�. -REVIEW
DATE
RECEIVED
DATE r =
COMPLETED
Rev. 8/2/17