HomeMy WebLinkAboutWatts, Donald Gas Permit ApplicationAll APPLICA► : 'SFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
avDate: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial _ Residential C
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:..—&1910
Property Tax ID #:
Site Plan Name:�� r 1�Jjf
Project Name:
Lot No.,—/ -6
Block No. f90
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
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor: '
— Roof Pitch
Utilities: —Sewer _ Septic
OWNERAESSEE: _
CONTRACTOR:
Name
Name:
Address:
Company:
P Y:
City: State:
Address:
Zip Code: Fax:
City: y`f
Phone No. -19'1:9v3
Zip Code:
E -Mail:
Phone N OZ
Fill in fee simple Title Holder on next page ( if different
E -Mail
from the Owner listed above)
State or County Lici
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.
Building Height:
Fax: —
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not Appl cpbtd
MORTGAGE COMPANY:
_ N,ot Applicable
Name•
=
Name:
Address:
Address•
City:
State:
City
State:
Zip: Phone -
r
Zip: Phone:
_
FEE SIMPLE TITLE HOLDS •
— Not Applicable
s
BONDING COMPANY:
Not Applicable
Name:
Name:
Address: _
Address:
City:
City:
Zip: Phone:
Zip: Phone•
OWNER/ COWRACTOR 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 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 I der or an attorney before commencing work or record I%your Notice of Commencement.
�].-
of
STATE OF FLOR
COUNTY OF
as Agent for Owner j Sign
Sworn to (or affirmed) and subscribed before me of
Ph �'cal Prese a or Online Notarization
this �ygay of 2020 by
Name of personjnaking statement.
OR P( duced Identification
STATE OF FLORID
COUNTY OF�
6W.4—
Sworn to (or affirmed) and subscribed before me of
Ph cal Pres ce r Online Notarization
this day of 2020 by
ntx
Name o person king statement.
Personal) own OR Produced Identification
Type o d$rs tcation
Prod ce
pp# Notary Public,State of rionaa LCO
•�CommissiCharmin D Walker 160'•",Notary Public State of Flonda
225EM-al) mmis I W
Charmin D - ker (Si
F Expires 0610612022
e y Commission GG 225827
�a. F o Expires 06/06/2022
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISOR I PLANS VEGETATION I SEATURTLE
REVIEW ! REVIEW I REVIEW REVIEW
MANGROVE
REVIEW