HomeMy WebLinkAboutMaliszewski Gas Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 15 Permit Number-
9V.LaC�I.
� ` �' `1 - 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: PeI„r rn/1.., �{i`��SLI
, //[
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Lot No.
Site Plan Name: 'Cec l TQ �?�, � � /Tamq 1
Block No.
Project Name: � 1 j�_� [ Vo
DETAILED DESCRIPTION OF WORK:
(QdM
a nV_3
New Electrical Meter Second Electrical Meter-- (Affidavit required) —
CONSTRUCTION INFORMATION:
Additional work to be perfo�ned under this p mit —check all that apply:
Pond
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Pitch
Total Sq. Ft of Construction: —045, Sq. Ft. of First Floor:
Cost of Construction: $ 3 L1 , 0J"_ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S Ze Res Name: 1
Address: 0G. Company: ?70rYY j C)i k Av
Q_ f
City: l' State: Address:MYD I 2j C,omrrlu'zQ '�
Zip Code: �JT4Q R U1 Fax: City ��
StateR
ZZ
Phone No. 79 - dV Zip Code: �jJ4 1 Fax:
E-Mail: Phone No IO 1
Fill in fee simple Title Holder on next page ( if different E-Mail
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from the Owner listed above) State or Cou4 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.
SUPPLEMENTAL CO
LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone .
FEE SIMPLE TITLE HOLDER: Not Applicable
MORTGAGE COMPANY: /Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: VNot Applicable
Name:
Name:_
Address:
Address:
City:
City:
Zip: Phone:_
Zip:
Phone:
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
wit�n or or an aXtorney before comme"igg work or recording your Notice of Commencement.
of Owner/
v
Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) us bscribed before me of Physical Presence or Online Notarization
this 1� day ofC&W20 Zf by
Name of person making statement.
Personally Known OR Produced !dnifirtionType of Identificati n Pro ucgd
(Signature of NcItary Public- State of Florida )
Commission No.� S 6Z7 (Seal)
REVIEWS
FRONT ZONING
COUNTER REVIEW
DATE —
RECEIVED
DATE
COMPLETED
SUPERVISOR
REVIEW t
I
f
FEED
-rota of Flondaalkern GG 22582712022
PLANS I VEGETATION
REVIEW REVIEW
SEA TURTLE MANGROVE
REVIEW REVIEW