HomeMy WebLinkAboutMarley Gas ApplcationAll APPLICABLE INFO MUST BE COMPkr- fED FOR APPLICATION TO BE ACCEPTED
Date: 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: �UG-
6 .7'6�
PROPOSED IMPROVEMENT LOCATION:
Address: NA)
Property Tax ID #: a 57~ �o3 — 00 All 00 — 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 performed under this permit— check all that apply:
_Mechanical Gas Tank _ Gas Piping
_ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers
_ Generator _
Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: Ffig Utilities:
—Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:_w 4
t
Company:
City: �II �i?C�i _ Stater
Address:
Zip Code: Fax: ��
City:
State:
Phone No3 05— f f ?5'- 0691W
Zip Code:
Phone No '"
Fax:
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail ` Y
7 `
from the Owner listed above)
State or County License
_ e3�Q!�
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 LAW IN
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: tate:
Zip: Phone
FEE SIMPLE TITLE HOL _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
BONDING COMPANY'
Name: 77
Address:
City:
Zip: Phone:
Not App ' le
State:
Not Applicable
ONER/ CONTRACTOR AFFIDVIT: Application is hereby made to tain a permit to do the work and installation as indicated.
ertify that no work or installation has commenced prior to the issu ce of a permit.
St. Lucie County makes no representation that is granting a pe, t will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Associ�t ion rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Associati6n 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 vour Notice of Commencement.
of Owner/
as Agent for Owner
STATE OF FLORI STATE OF FLORI
COUNTY OF AQ�V COUNTY OF —IN
Sworn to (or affirmed) and subscribed before me of
P ical PresepQ or Online Notarization
this ay of 2020 by
Holder
Sworn to (or affirmed) and subscribed before me of
Physical Prese a or Online Notarization
thisay of 2020 by
Name of person making statement. Name of person making statement.
qof
own OR Produced Identification Per Wally K own OR Produced Identification
ification Tpe of Ication
ro
(Signature ! ic:§taf �ln"rid�'� acre4t
Charmm D Watker BG�EI�FF�tiB of lorida )
Commission NO. My Gomm�ssion GG 225g27 �. Cha omlD ms o 225827
Walker
GG
x
rzoza (Seal) °aos 06 afi2no7 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE l
RECEIVED
DATE j f
COMPLETED