HomeMy WebLinkAboutOconner gas permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number-
,�Ir
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i Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982 r
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 3569 % " !L0 OLQ 3 —,�06 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be perfo ined under this p�rrhit — check all that apply:
_Mechanical _Gas Tank 4 Gas Piping _Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:__ - -
Cost of Construction:- Lf
OWNER/LESSEE:
Name
Ir
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
CONTRACTOR:
City: State:^�
Zip Code: Fax:
Phone No. 3 42—
E-MaiIT�2l/C�tg1,j-A0�/P.1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company: f
9�
Address•
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U`P
City:
State:
Zip Code07—
Phone Nn
r�Fax:
,
State or County License
4
If value of construction is 2500 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.
SUPPLEMENTAL CONSTRUCTION LIEN
DESIGNER/ENGINEER: _ Not Ap 1i
Name:
Address:
City: ' State:
Zip: Phone
FEE SIMPLE TITLE HOLDER.
Name:
Address:
City:
Zip: Phone:_
W INFORMATION:
e
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Ph e•_
Not Applicable I BONDING
Address: _
city.
Zip:
Phone:
Applicable
State:
Not Applicable
OWNER/ CgMtRACTOR AFFIDVIT: Application is hereby mail' to obtain a permit to do the work and installation as indicated.
I certify th o 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commenciN work or reccoor ur tice of Cormencement.
*0' )
as Agent -for Owner/' "I Signature of
STAB OF FLORID►eI J `
COUNTY OF
SwW to (or affirmed) and subscribed before me of
Pxsical Presen or Online Notarization
t Kis day of 20220 by
Namep€p�rson making statement.
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of Ideptifficatioq
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Crmission No.
REVIEWS FRC
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DATE
RECEIVED
DATE
COMPLETED
ev. S/6/20
OR Produced Identification C
State of
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Charmin D Walker
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STATE OF FLORI
Holder
COUNTY OF elt
Sworn to (or affirmed) and subscribed before me of
Physical Presence Online Notarization
t his-- day of (.0 ,C C2020 by
Name of person Oking statement.
I y Knawn OR Produced Identification
of Identi#icatiort
of Notary Public- ate of Florida )
PLANS ; VEGETA'
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Notary Public State of Fonda
Charmin D Walker
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Expires 051051H
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EVIEW REVIEW