HomeMy WebLinkAboutMESSER APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�Ir dCjC�DL Fes,
Building pp Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:GAS PERMIT
PROPOSED IMPROVEMENT LOCATION:
Address: 6820 GRAHAM RD
Property Tax ID #: Parcel ID: 2313-313-0002-000-2
Site Plan Name:
Residential x
Lot No. —
Block No.
Project Name: Steven Messer
DETAILEDDESCRIPTION OF WORK:
BURY 500 AND RUN LINE TO EXISTING STUB
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 _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2425.0 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name; , ,� 'r
Name:
Address. C ' r IY
Company:
City:�� 1. (Lc Stater .
Add s:J
Zip Code: Fax:
City.
State:
Phone No.
Zip Code: l� `� Fax:
E-Mail:
Phone Noq� DC
Fill in fee simple Title Holder on next page ( if different
E-Mail ^ ?a
from the Owner listed above)
State or County License
iN ' k
it value or construction is zSUU 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:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
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 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 lender or an attornev hefnre rnmmPnrina wnrk nr rPrnrriina vniir Nntira of rnmmAnrnmAnt
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF \���.. '�
STATE OF FLORIDA v j
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
hysical Presence or Online Notarization
this i.' ` day of � , 2021 by
4�
thi s} day of �' a. 202$ by
f
Name of person makin atement.
Name of person making st4tement.
`'j
Personally Known OR Produced Identification
Personally Known; OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced '1
(Signature of Notary Public- State of Florida)
(Signature of Notary P'sli State of Florida )
�►� 'v" .. KRISTEN AAARiE FOLLAN0
Commission No. , ) Netar! Public State of Ffori
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mmission No. :� I !`N BRIE FOLLANC
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�' 1R Cc' mission ; HH 64933
M;COMM. Expires Nov 18, 2024
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Rev.5/6/20