HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 2 t5 Permit Number:
r-
JAN 13 2020
--- - Building Permit Applicatio
Planning and Development Services Lucie County, permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential J�
PERMITTYPE:GaS
Address: 7lQl of tYll- I a Vr, ( AY , rurt J-1—I A.)( 4 -9 T l, )—IL 16L'p I f
PropertyTax lD #: 3J2� Lot No. y
Site Plan Name: nn ) tkn Block No.
Project Name:
�CINrvTRI61(TIt7�Ni INFnI RIVIATiIOW'
Additional work to be performed under this permit— check all that apply:
_Mechanical > as Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $,9,-A`, ``6p Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER%LESSEE_! F
lIIA
GONTR'AGTOR ,,'. "- LL
Name f-
Name: Blake Cowdell
Address: a
Company: Energized Gas
City: Stater
Zip Code: Fax:
Phone No.
Address:1786 Biltmore Street
City: Port Saint Lucie State: FL
Zip Code: 34984 Fax: 7723186672
Phone N0772-466-1095
E-Mail:el=951=
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
enerators ized
E-Mail ener 9 9 @gmail.com
State or County License LG34747
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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:
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.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YnuR IFNDFR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO IDA
STATE OF FLO
COUNTY OF 7) (f,( p
COUNTY OF
The forgoing instrument was acknowledged before me
The fo oing Instrument was acknowled ed before me
this day on TG�Y 20�by
this ay of 20fl by
Io�P rN AV"Yl I
Name of person making statement.
Name of person making statemen .
Personally Known OR Produced Identification
Personally Known - FOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
T'. G _
(Signature of blic. 'Dmd
(Signature of Not c;,`ita e
og F� : Ju a 27, 2U22
MY coMMISSION # GG 232946
Bonded Thn�No
Commission N s". •`a EXPIRES:
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Commission No.
•.„oii°•' Bonded Thor Notary Public UndervMUNS
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. z/i/IV