HomeMy WebLinkAboutJames Gas Permit ApplicationAll APPLjI BL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1
Permit Number:
Nr.auc m
� � 3
Planning and Development Services Building Permit Application
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:
Property Tax ID #: I " o0o - 3
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
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: $
OWNER/LESSEE:
Name lg(AdT'I.A +
Address: 140
_ Generator —Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
City: State: {1..
Zip Code: 2i8n: -- Fax:
Phone No. -71 1q 01
E-Mail:J-'`gMk,5md @oTmuk ((,)yy�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:Ai Lit
,
Company: MAy
Address:
City: r+ State:
Zip Code: ! Fax:
Phone No
E -Mail YY1Q, COY�(0 d�. - t:A vn
State or County License 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.
DESIGNER/ENGINEER:
Name:
Addre .
City:
Zip:
FEE SIMPLE TITLE HOLD
Name:
City:
Zip: Phone:
Not Applicab
State:
_ Not Applicable
RTGAGE COMPANY:
Nanit-,
Address
City:
Zip:
BONDING COMPANY�
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is`�'ftereby 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 andcovenantsthat 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.
ofpwne / Lessee/Contractor as Agent for Owner I Signature of Con ctor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF cKo�.� _ COUNTY OF FLORIDA
Sworn to (or affirmed) and subscribed before me of SV9rn to (or affirmed) and subscribed before me of
)� Physical Prese ce or Online Notarization A. Physical Presence or Online Notarization
this day of O 2020 by this _L day of 2020 by
Name of Pers n making statement. Name of personLmaking statement.
Personally Known X_ OR Produced Identification
Personally Known _)<. OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(SigrVatVreW A to y P
liPE, of F o y BROWN
(Signature of Not Pub "
Commission No.
:Notary Public -State of Florida
Comrl al�n # HH 37071
Y CCOrn
Commission No.
SPAY PUe
""""� MARY BROWN
_° _Notary(gel�llk-State of Florida
fission Expires
Au U 26, 2024
Commission # HH 37071
My Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MAN
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED