HomeMy WebLinkAboutBlair Gas Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:` Permit Number -
CC UL' w _Y
r L `' c, 1 '-' L 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
PERMIT APPLICATION FOR: O� - -- —
PROPOSED IMPROVEMENT LOCATION: yy----
Address: _�),494 5D UAE6M3 n
Property Tax ID
Site Plan Name:
Project Name:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
ON
;.
Additional work to be permed under this germit - check all that apply: —
_Mechanical Gas Tank ✓./G'as Piping Shutters Windows/Doors Pond
Electric —Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: - _ -, a _ Sq. Ft. of First Floor: 173
Cost of Construction: $ _____,Q�. Utilities: _ Sewer ✓Septic ABuilding Height:
OWN
Nam
Addr
City:
State:
Zip Code: Fax: ,fir
Phone No. i
E-Mail:
Fill in fee simple Title Holder on next 4ge ( if different
from the Owner listed above)
Name: o1w
Company :(�DrJ 61,1rC. Mf 4AAr .0f- R,
Address: 1101 C0Mrr4YT_L NVV-
City: VU-b &'0'Ch State: �—
Zip Code: !32A UO Fax:
Phone No'i�12"12� �02�lI
E-Mail r
OaVlrybe d fAv'v)
State or County license i
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
R: _ __ iVnt Applicable _'7mORTGAGE COMPANY: _ Not Applicable
Name: '
Address:
City:
Zip:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Zip: Phone:_
me:
Ad
State: City:
Zip:
Not Applicable BONDING
Name:_
Address:
City:.
Zip: - --
Phone:
Phone:
State:
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 tender or an attorney before commencing work or recording your Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLOR0D� � �
COUNTY OF
Sworn to (or affirm.'d) and subscribed before me of Physical Presence or Online Notarization
this t01 day of 20_U_ by
Name of person making statement.
Personally Known OR Produced Identification X
Type of Identifkation Produced_
(Signature of "IN
ry Public- State of Florida
, MARY BROWN
Commission No. (Se Ir ems- Notary Public -State of Florida
Commission # HH 37071
My Commission Expires
+'' August 26, 2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED ! _
COMPLETED