HomeMy WebLinkAboutBuilding Permit Application �e
ALL APPLIC E NFO MU TBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: l o ` 0✓ cLi
RECEIVED
Building Permit Application MAR 3 0 2016
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: I
ENT LOCATI®N K
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Address: S 1 �J ht7�'� `( e_e� �� �r e.�e` , �� 3yIOi,$Z
Legal Description: Q,ro�v'f" Bark S ��� 0 - Lz,+- I-Oks �j Ho-4LI3 " 44
An&LVac. 10 /al1ty fid; rnn S a LvF y2 C+5in 8+f-I o cac'%k) 551 Sim- �'L 34`1M
Property Tax ID#: 3L4 C)9" Ube(O-Opo-L( Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Aaditional work to be nertormed under tis permit-check all appy xtth..Ck
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing. Sprinklers 0 Generator 0 Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ ? SENT.0-0 Utilities:Cn Sewer 0 Septic Building Height:
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OWNE LESSEE0 Qr k kCONTRACTUR k
Name eA GLAO-oc. � Name: Robert Zrallack
Address: SS t =1 S)-NLW+ S"T�+ Company: Solar Energy Systems
City: f-=,'r-' - V1,C'r _ State:_ Address: 160 Smallwood Avenue
Zip Code: 'a 4CI$D. Fax: City: Fort Pierce State: FI
Phone No. Zip Code: 34982 Fax: 772-466-7937
E-Mail: Phone No. 772-464-2663
Fill in fee simple Title Holder on next page(if different E-Mail: vpsolarenergy@yahoo.com
from the Owner listed above) State or County License: CVC056637/9057
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 your Notice of Commencement.
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Signature of Owner/Les gent Signature of Contract L�ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9:L+Uay of_(YJ Q_<C1--, 201LObv this?_O'day of(Y)CkCCS ,20 _L_(p by
(Name of person acknowledging) (Name of person acknowledging)
'tj �itc¢ IaA �Wulo(/_
(Signature of Notary Public-State of Florida) Signature of Notary'Public-State of Florida
Personally Known OR Produce
icKwo Personally Known // OR Produced Identification
Type of Identification Produced- Type of Identification Produced _ftANWA*_ M8ft Sarah Music
STATE OF NOTARY PUBLIC
Commission No. FLORCAommissionNo.r)'-�?f 07 STATE OF FLORID,i
CM"FF911211, L a)
Expires 8124/20 9 C~FF912137
81241201 ,
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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INITIALS