HomeMy WebLinkAboutBuilding Permit Application s
s
ALL APPLICAB INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (� � Permit Number:
•
Building Permit Application
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Sd
PROPOSED IMPROVEMENT LOCATION:
Address: 1 YV3 to C A A)C&A) d26—FA ,1'C
Legal Description:� i sk Z � Fe-.eruo- s " 1—kolj65444-5-661Q 561-9y7)1Aaf Prf eSec. '*S
S4oWnin D2 RD-113g6ei Lot1Y'136 CWA;Cy"44k a8i-is)�b.13AC10X3b-*4CA
$14peerty"Tax ID#: /3 -:5,61-0 -0ey-I/ Lot No. )yq.3&,
Site Plan Name: M 1__CA Ae1 gQ(A.rg/ Block No.
Project Name: )'1'l �UnA.,--,( ' D"A6/
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be ne rmed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
11 Electric 0 Plumbing F]Sprinklers ElGenerator El Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ r a7 Utilities:Sewer E]Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Y O n Name: Robert Zrallack
Address: 1 t44 3(o C.4Lr\ -tom n A� v eNux-r— Company: Solar Energy Systems
City: to f _- A(:r[t- State: R_ Address: 160 Smallwood Avenue
Zip Code: 341 S I Fax: City; Fort Pierce State: FL
Phone No. &/b•��� 56010 Zip Code: 34982 Fax: 772-466-7937
E-Mail: i ke anbio, M.CmAl Phone No. 772-464-2663
Fill in fee simple Title Ho der on next page(if different E-Mail: afsolarenergy@bellsouth.net
from the Owner listed above) State or County License: CVC056637
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
f
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
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
commencing work or recording our Notice of Commencement.
-2dj�ftt 7A 41 s
_Signature of Owner/Lessee nt Signature ofontractor/Lic a Holder
STATE OF COUNTY OF ISA,
ISA, L ArA e lid , OUNTY OFSTATE OF ORIDA9k Lcx4e_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2..7*hday of Or4obZK 20 15J by this Z14-"day of 0CA-pfit' ,20 )'Sby
(Name of person acknowledging) (Name of person acknowledging)
2&adi eqA-a222=,U !//Gtr r� /cJGtA
Si b
( igSno atu a of Notary Public-State of Florida) ( Public State of Florida
(Signature of Nota rY )
Personally Known �/ OR Produced Identification Personally Known V // OR Produced Identification
Type of Identification Produced M4116—IiiiiFMIJ 3IFype of Identification Produced MaffPLIBI JC NU FAKY U
Commission No. E-Fch Z 137 NATE OF FI. FWAnmission No.FF q1 Z 13 7 STATE OF!!� jt
A
CdnnW FF912 37 %- )- E)#r9s8/24/2
Comm#FF9121
res 9
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS