HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: la`'��1 kn
SCANNED
BY
St. Lucie ^�,Inty
Building Permit
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
Permit Number. V1 \ d 013 q
RECEIVED
nOCT 3 0 2017
Permitting Department
St. 1.PAW&ownty, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: 7Zi(0CI (Drnrn )rcci YL %r. F-� Fi p!-ce 6::L 34GiSj
Legal Description: Ai W a" Taus-h-cQPa( K-lfn'��t� �LvLfl i TIS (0,5L 8X,3 ogl o-
'ILUog ConNyr rc:c.Q C-ir (_-; cx. rrt_3eIGSl 1858
PropertyTaxlD#: 13 5- gr71- OC)Ilo- 000-Qo Lot No. 15
Site Plan Name: Block No. F}'
Project Name:-7/j';,— `�r�7 �E .d.nc
Setbacks Front Back: Right Side: Left Side:
50C W CLEG77�IC-I(9 t( StJ54 m
awuunai wurK Lu ae
enurmea
Gas Tank
unaer mis perrna—cnecx au
❑Gas Piping
apply:
❑Windows/Doors
_Shutters
��Ll�yyHVAC
Electric
0 Plumbing
Sprinklers
11 Generator
E—] Roof
Total Sq. Ft of Construction:
Cost of Construction: $ Epp, a
Sci. Ft. of First Floor: _
UtilitiesSewer E]Septic
Building Height:
E) E�/LESSEE.:
CONTRACTORS
�.
II--'
Name flpPie ie Tn�
Name: RobertZrallack
Address: % dl C9m6yrcied, Cir.
Company: Solar Energy Systems
City: C-1- Pi erne_ State -.FL
Zip Code: 3 L1 q5-1 Fax:
Phone No. 95 cI g5(0 - -IcJ (oa
Address: 160 Smallwood Avenue
City: Fort Pierce State: Fl
Zip Code: 34982 Fax: 772-466-7937
Phone No. 772-464-2663
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: vpsolarenergy@yahoo.com
State or County License: CVC056637 / 9057
If value of construction is $250D or more, a RECORDED Notice of Commencement is required.
GHEEr., ,
ENIiAL CONSTRUCTION
o '"FORMATION:
LIEN W-IN
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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
qUtL�� � x �� s
_ Signature of Owner a/Agent Signature of Contract 'cense Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this ay of 0ab69dZ 20 L-1by
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this aL' day of oJV % , 20 L by
RobertZrallck Robert Zrallack
(Name of person acknowledging) I (Name of person acknowledging)
/JA.ee /la&, ///I�ntL 141a4'e- /,ku Cam- ��..mCli
(Signature of Notary Public- State of Florida) (Signature of Notary Publi - State of Florida )
Personally Known OR Produced Idelotia io Personally Known I/ OR Produced Identification
Type of Identification Produced [�tlC Type of Identification Produced Made Sarah Music
NOTARY PUBLIC
Commission No. y I Z 3� ffATE OF FLORIDA Commission No. —rglZl % DATE OF FLORIDA
Cbmm# FF912137 Comm# FF912137
Revised 07/15/2014
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