HomeMy WebLinkAboutKnight Gas ApplicatoinAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
ME I
F L
0,.,R A •D
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: ecu )DO"�
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax I D #:
Site Plan Name:
Project Name:
1gl a►11l pill
•41 1 •
DETAILED DESCRIPTION OF WORK:
a on :
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be perf rmed under this permit— check all that apply:
_Mechanical las Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
—fes t K
Cost of Construction: $ tip
_ Generator
Sq. Ft. of First Floor:
Lot No. a
Block No.
Windows/Doors _ Pond
_ Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: ' CONTRACTOR:
Name _
Name:
Addres :.1
"Fax-
r •
Company:
r
City: State:
Address:Zip
Cod
City: ('
Phone Nt.
Zip Code:
E -Mail: y��
Phone N
Fill in fee simple Title Holder on next page ( if different
E -Mail c(
from the Owner listed above)
State or County License
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.
Fax:
_ 1,I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER:
Name:
_ Not Applicable - "
MORTGAGE COMPANY:
Name:
Address:
s City:
Zip: Phone:
_ Not Applicable
State:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER.
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City: `}
Zip: X Phone:
VE TATION
Address:
MANGROVE
City:
COUNTER
Zip: Pho
REVIEW
OWNER/ NTRACTOR AFFIDVIT: Application is hereby made to obtain a permi to do the work and installation as indicated.
I certify t no work or installation has commenced prior to the issuance of a permi
St. Lu�islln
ounty makes no representation that is granting a permit will authorize t e permit holder to build the subject structure
whi conflict with any applicable Home Owners Association rules, bylaws o and covenants that may restrict or prohibit such
str cture. 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 commencing work or recording your Notice of Commencement.
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Signature wner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIQA
COUNTY OF
S rn to (or affirmed) and subscribed before me of
4k,Wsical Presence or Online Notarization
t is day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification y
T e f tificati
rod fk4l
Ji" -nature of Notary Public- State of Florida )
CommissionT-VR_4�._
tic state 1AMO +a
�Char.,inD Walkervssion GG 225827
Signature of Contractor/License Holder
STATE OF FLO D
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
—r4 yslcal Pres e e Notarization
this day of o nlin2020 by
Name of person making statement.
HallK own OR Produced Identification
of Id nti cation-
,(Signafure of Notary Public- State of Florid
Y Notary Public state Ion
Commission N oma' `t�� D WalkJbeaf
My commissionGG225827
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REVIEWS
ARVI SO R
PLANS
VE TATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
-
DATE
COMPLETED
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