HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPIPCA LE I/N�F MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rl
Date: 1
30 Permit Number: v q � O
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Building Permit Application
Planning and Development Services St 09,0 IQ�
Building) nd Code Regulation Division Q F,
2300 Vir4inia Avenue, Fort Pierce FL 34982 4lz*; �F
Phone: (p72) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
,PROPQSED� IM-OROVEMENT LOCATION;
Address: I tG22-q n , ^
Legal Des, iption: (- a6c_z l.� �d`�-�C, VL
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Property j1xne.4-:E!>j1
ID #��- � Lot No.
Site Plan IV����Block No.
-Proiect Ne.
Setbacks II Front Back: Right Side: Left Side:
Dfl'AILE DESCRCPT1- N,OF WORK
CONSTR•_� CTION INFORMA__TIQN,,:,
- - - Addi
n'H
ona I or to fee a orme un er t is permit- c ec a appVACi L__I Gas Tank ❑Gas Piping Shutters a Windows/Doors
a�lecti c El Plumbing Sprinklers Generator Roof Roof pitch
IT otal Sq. Ft f Construction: q C S . Ft. of First Floor:
Cost of Con ruction: $ �� /J utilities:RSewer Septic Building Height:
OWMtR LESSEE
CONTRAOR..
CT
�:. - - - - -
Name
Address: )
City: '
Zip Code:
Phone No.
E-Mail: "I
(Fill in fee si
from the O
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Name; Micheal Flaxman
Z� l 1. _ -�h (`r'
Company: Energized Electric
I lryl CI'I— Statef
C] ax: a 3) 4Q(Z5.a
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Address: 4252 Bandy Blvd.
City: Fort Pierce State: FL
Zip Code: 34981 Fax: 772-318-6672
hone No.772-466-1095.r, -
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v'� 26P
I le itle Holder on next page (if diife
er listed above) "
ail:
State or County License: .
value of construction is $2500 or more, a RECORDED Notice of Commencement is requiretl.
T�
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE'TITLE HOLDER: _ Not Applicable
Name:
Add ress: 4252 Bandy Blvd.
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable;,
Name: Micheal Raman
Address:
City: 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. "
Inconsideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work I'
in accordance with the approved plans, the Florida Building Codes andrSt. Lucie County Amendments.
The following building permit applications are exempt from undergoing a.full concurrencyreview : room additions, I�
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 beforle
commencine work or_recordine vour Notice of Commencement.
r
Signature of O ner/ Less a/Contractor as Agent for Owner Signature • C tractor License Holder
STATE OF FLORID I ; 1.0 STATE OF FLORID
COUNTY OF 1—� ! t� COUNTY OF vGl�
The org of
ent w_Jras cknowled efore me
th s a of �20� by
i_ c, ea I o'-know—)
Name of pe� making statement
Personally Known OR Produced Identification
Type of Identification
Produced�e�� fl �`—� I�
A l� ( )
re of NotaryPublic- State of Florida )
Commission No. (Seal)
The forg�r�i�nstrument wats cknowledg�efore me
this y o� 20 by
Name of pyr qn making statement
Personally Known A— OR Produced Identification
Type c Identifi�t , n4 � '`� l r— ,n,
Produced V_C.i J0 � '�•� ( lam► l��J
re of Notary Public -State of Florida )
mission No. (Seal)
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