HomeMy WebLinkAboutStockwell Gas Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:r 14 Permit Number:
91r. Wag
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:
PROPOSED IMPROVEMENT LOCATION:
Address: If D- - 9DRL k l Gi` �--Oy I�Y(Q-. fi-- )
Property Tax ID #: - QQo -.3 Lot No.
Site Plan Name: ++O D Pkiay,,_UT Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
IMCL 0Y h0A1-P v- S L -,I)
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical e Gas Tank Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 41W q o
OWNER/LESSEE:
Name A -f Y)tA Ck
_ Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
— Roof Pitch
Utilities: —Sewer _ Septic
Address:g1fJ* 2UI'LQ, 9..Idl &
State
Ft,
�Ie`CR.
FL -
Zip Code: Fax:
Phone No. 71 021 b
E -Mail: (Y)1A ra 4,n-01G_CAl1'3
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:
Company: rl(t0
Building Height:
Address: Wd IYIIYWQL -kV
City: 9'W0 _+ State: PL_
Zip Code:3"ci Fax:
Phone No-M'7r{Q(Q(,G '
E -Mail M4 b G corroflpnA&. cOm
State or County License L_-t5eqq Ll
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 INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Addre Address:.
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE H
Name:
Address:
City:
Zip: P
_ Not Applicable
BONDING COMPANY
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 theermit 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 commencing work or recording your Notice of Commencement.
I ZZ
Signature of ner essee/Contractor as Agent for Owner Signature of CIV
ractor/License Holder
STATE OF FLORI
COUNTY OF .1
�vyorn to (or affirmed) and subscribed before me of
J� Physical Presence or Online Notarization
this � day of Q1 _ , 2020 by
STATE OF FLOIU CMIQ�
COUNTY OF ��,,,,��
Sworn to (or affirmed) and subscribed before me of
Physical Presencq or Online Notarization
this day of 2020 by
�A A be r cin n U U l btrso-►n
Name of pe son making statement. Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification
(Signature ofaPypl,l X?ff sdwwo d��
ILOL£ HH # u0l9slww00
Commission No. a uo o e}ei�-oilgnd (Gealh
NMO88 AUVN
Personally Known 14 OR Produced Identification _
Type of Identification
Produced
(Signature of Nolta u,13§4 to a BROW N
?:° Notary Public -State of Flori
commis
Commission 37071
Commission No. "• My Com n Expires
' August 26, 2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE _
RECEIVED
DATE
COMPLETED
ev.ST6/20
MANGROVE
REVIEW