HomeMy WebLinkAboutCarolyn & Ken Ball Gas permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
o �.
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: -"
Address: "161 7Yn�� ). J�►^I�OP Pnti zl jC:'%Y0i,
Property Tax ID #: VW,�-'Yd f " 000.5-OdD -
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical X Gas Tank !as Piping _ Shutters
_ Electric _ Plumbing I_ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ �, / �.
OWNER/LESSEE:
Sq. Ft. of First Floor.
Lot No.
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
CONTRACTOR:
Name KemeMiZ/
Address: YOI 7r- o adge d
City: r-opq-P i erne State:
Zip Code Fax:
Phone No(d399,
E-Mail '/1 ey Ina . r! oln
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:/%,"
Company:
Address: rX U
City: sf4_ State:,,
Zip Code: Fax:
Phone
E-Mail CCU r 14/Srn1,) A1ner`.1n 0m
State or County Licensi 19 f L
If value of construction is 25W or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I
FSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ESIGNER/ENGINEER: _ Not A cable MORTGAGE COMPANY: _ Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip; Phof e:
FEE SIMPLE TITLE H ER: _ Not Applicable BONDING C PANY: _Not Applicable
Name: Name:
Address: Addres
City. City:
Zip: Phone: Zip: Phone:
OWN / 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 Horne 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: roam 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 Mwit in paying twice for
improvements to your property. A Notice of Commencement musthe--Fecor d in the public records of St.
Lucie County and posted on the jobsite before the first inspectigrr. if you inte d to obtain financing, consult
with lender or an attorneybefore commencing work or reco in our Notic of Commencement.
',4 AA I& L
Signature of Owner/ Lessee/Contrkq2r as Agent for Owner Sin a of etor ce older
STATE OF FLORIDA
COUNTY OF JM M- Ao'l /h
Sworn to (or affirmed) and subscribed before me of
P ysical Pres ce or Online Notarization
t is day of
Nan�e,pf person making statement.
Known OR Produced Identification l
of
(Signature of Na
rU�T Notary Public State of Florida
Commission No. Charmin D W rt'
11 mission ��5827
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VIEWS FRONT ZONING SUPERVIS
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ATE OF`Ft
)UNTY OF
Sworn to Foor affirmed) and subscribed before me of
--XPh sisal Presen a or Online Notarization
this j day of l( 2020 by
61
Name pi -person making statement.
inally Known OR Produced Identification 4LC—
of 1 ntificat[nn _
•I f
(Signature of
Commission No. ram` "' W Notary Public S londa
-_Charmin D AW4
Y My Commission GG 225827
-Z o • o Expires 06/06/2022
PLANS VEGETATION SEA TURTLE MANGROVE
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