HomeMy WebLinkAboutDoole gas permit app (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
(�b J
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
Address:
Property Tax ID #
Site Plan Name: _
Project Name: _
New Electrical Meter Second Electrical Meter
(Affidavit required)
Lot No.
Block No.
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: $ _� Utilities: —Sewer _ Septic
Name (A' - 41 Name:
Address: QL4 %1)kJ(A1V-)T`-- A _o"ts Company: ., r,
City C i t`-.° �"! C �C .. State: Address: ..A%i c °
Zip Code: 1 Fax: City:)`f C
"4 -.
Phone No. Zip Code:
E-Mail: `f' " „' .Y\ Phone No f�
Fill in fee simple 4itle Holder on next page ( if different E-Mail Ci (
from the Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Building Height: _
r
State:
_ Fax:
ILl5i
'221-X,
OESIGNE
NGWtER.
Not Applicable
MORT GE
COMPAXY.
Not Apprvweeaamne icable,
Nanr
�e:,
Address,
Mdress;
0ty:
State:
City
statw'
Zip: —
Phone—
zip.,
Mow —
FEE SIMPLE TfTLE HOLDER:
�Qt ipplicable
BONDING COMPANY.
Aprifitable
Name.,
—Not
Address:
Address -
GUI:
City-,
Pbone.
zip:
pttone"
UWNEg/ ESN T"t-JUR AJIFILIVIll ApplicatiOn is herebyMode to abIsikn a ptimit ta ttit *of*- And foist 4fkitjo4i as liwirated,
I certify that rmwafk ot Jasl#lfattion has torrim,@Med prior to the Isviance of a permit
St 6ude Cam vmake� fW that will authorize t�! rmk h*Wer tobudd the subject structure
Which is In con kt weth 8,0v av r c
olkable Ho ", Owf*rs Asti tion rWas b, qe
structure, Pteaw comuft with ywr Home 0*-nm Asuxtation, and rfti�� V urr r irq resthdiorr$ wt1kh my, 4,opjy,
In ceps WeNtion of tM grarttkV of this rested permit, 9 do hereby nnie, that [ witi, In 4f respecAs, pe;-form me wafk
m accordance nth tho approv&l Oans., the Fkvida %Wrfing Code and St. Lucie Cw4rvtV Amendments,
The fo#ov*.% buiWing petwA applications are exempt frorn sand "going a falkoncurrerucy rewvtw: room additions,
acc"wy structutes, swintmittS pocgs, fencin, walk, Arts, vjart room amda=esgofy kaft tol."th.c." ivll UW
WARNING TO OWNER: Your faiture to Record a Notice of Convive- me may rftWt In paong twkit for
impromments 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 finansbrig, consuft
with tender or an attorney before commencing work or recording voter Notice of Commencement.
*natti%e of Ow"mr! tee see/Contractof as, t for Owner
STATE Of FLOWDA
COU f Pt mot. 0
Swor tq for affirfmAAnd subsaibed before m of phwical PremrKg tar- Ontme
this T�44y
Name of P"Wn "Y'W% statemem,
P"esonally Known ___ OR PtMmIc-0 tdc"tificatim,
71-
DANIELLE P. ZIMMERMAN
State of Florida -Notary Public
Commission # GG 141634
My Commission Expires
September 09, 2021
REVH s FRONT ZONING SUPERVISOR PLANS 1 VEGETATION 'I SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW 1 REVIEW i RtVIEW
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