HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: J —7k - 041
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 X
PERMIT APPLICATION FOR: Gas piping i
PROPOSED IMPROVEMENT LOCATION:
Address: 13407 NW Wax Myrtle Trail Palm City FI 34990
Legal Description: Harb. Ridge Palt No 1 lot 4
Property Tax ID #: 443660100040004
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side
Left Side:
DETAILED DESCRIPTION OF WORK:
r,s-6..11 So' ya-S l;^e. L? 't""nk eA^A
YNe:a fie' crw6;r
Lot No.4
Block No.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit — check
11HVAC Gas Tank �✓ Gas Piping
all
apply:
Shutters
❑ Windows/Doors
Electric ❑ Plumbing
Sprinklers
_
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S . Ft. of First Floor:
Cost of Construction: $ 295.00
Utilities:11 Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Jack Tickens
Name: RobertBinkowski
Address:13407 NW Wax Myrtle Trail
Company: Energized Gas
Address: 645 NW Enterprise Drive #107
City: Palm City State: _
Zip Code: 34990 Fax: Port Saint ICUie
City: Port Saint IUcie State: FL
Phone No.
Zip Code: 34986 Fax: 7728773614
E-Mail:
Phone No. 7728773440
E-Mail: Antonella@Energizedgenerators.com
Fill in fee simple Title Holder on next page ( if different
State or County License: 34747
from the Owner listed above)
it value of construction is �2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I I
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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.
s
Signat e of Owner/Lessee/Con-tractor as Agent for Owner Signature of C tra for/License Holder
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF .�Ot7 r 11 La"t COUNTY OF flf 4kCAV--
The f r oing instr meet was acknowledged before me
this day of ffyj 1 20 �by
(Signature
Personally Known OR Produced Identification
Type of IdentificatPn-Produced
Commission No.
Revised 07/15/2014
Notary Pub!ic State of Florida
My Commission FF 191201
Expires 02/27/2019
The forgoing instrument was acknowledged before me
this A day of AQYi 20 )'Y- by
(Name of son acknowledging )
(Signature of Notary Public- State o lorida
n,lS / )
Personally KnowOR Produced Identification
Type of Identifi tion Produced
Commission No.
Notary Public State of Florida
Antonia M Paula
My Commission FF 191201
Expires 02/27/2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS