HomeMy WebLinkAboutEpstein Gas Permit ApplicationAll APPLICABLE INFO MUST BE COL RED FOR APPLICATION TO BE ACCEPTE
Date:_L0 Permit Number:
Sir. WCUIE
c o
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
Address:
Property Tax ID #: C{"O'�j �� -� - - Q Lot No.
Site Plan Name: PU.D 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 X Gas Tank X Gas Piping _ Shutters
_, Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
OWNERAESSEE:
Address: I5O+NINLaf✓�;S C
City: PtY ru, State:
Zip Code: -"_q 9 Fax:
Phone No. _77 �- r.>' (O'?- (POLj
_ Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Utilities: —Sewer _ Septic
E -Mail: I Arry (90 p rrwi4.COI'1''1
Fill in fee simp a Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: 0L1) ,fsr,
Company:com b U
Roof Pitch
Building Height:
City s2LL State: f -t,
Zip Code: 3 g1 Fax:
Phone No i 1pa- (010 0 '
E -Mail MOLrvib
e comoRpyi6(►L • cgryi
State or County Licenseol�
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.
.{r 1
./ /rte jj�
P
DESIGNER/ENGINEER: _ Not Applicable MORTGA COMPANY• _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: PhQne Zip: Phon
FEE SIMPLE TITLE HOLDEN. _ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
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 bylaws
rules, 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 commencing work or recording our Notice of Commencement.
7-)a" '(�Vl hM4��'
ignature of ner/ Lessee/Contractor as Agent for Owner-Signature
__' —
of Con ctor/License Holder
STATE OF FLORIDA
STATE OF FLO IDA
COUNTY OF Q / j
COUNTY OF U VU dW
Sworn to (or affirmed) and subscribed before me of
X Physical Pres Online Notarization
S orn to (or affirmed) and subscribed before me of
rice or
5
Physical Presence or Online Notarization
this day of 2020 by
this __C)_ day of 0f, 2020 by
son
r n n� Gul_b r_&& In
Name of persbn making statement.
Name of pers making statement.
Personally Known X OR Produced Identification
Personally Known Y OR Produced Identification
Type of Identification
Type of Identification
Prod ced
Produced
(Signatu a
(Signature o Nota y P ii.aXe F Y BROWN
At. (Signature
y MARY BROWN
Commission{ :Notary Public-Stat orida
ission #
= Public-State of Florida
Commission No. =;, ;= Comm(( {I# HH 37071
�.,,
HH 37071
'�,orr;o�A�� My Commission Expires
o.,.� My Colnmis'sion Expires
j�"���"'�� August 26, 2024
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev.5/6/20