HomeMy WebLinkAboutBuilding Permit Information� - 7
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ALL APPLICABLE INFO MU T BE OMPLET D R APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
RECIEVED
Building Permit Application OCT 2 7 2017
Planning and Development Services
Building and Code Regulation Division permitting Dept. St. Lucie County,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION:
Address: bolo A I (GC P16,,c-e r i epee 1=L. 3 Ci %Y%Z
Legal Description: Palm Grove
Property Tax ID #: 3410-503-0317-0003
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side
Left Side:
Lot No. 33
Block No. L
I DETAILED DESCRIPTION OF WORK: I
Install 500 gallon LP tank and gas line to generator and final connect
CONSTRUCTION INFORMATION:
Add itional work to e e orme under this permit- check a apply:
F]HVAC W1 Gas Tank 7Gas Piping _ Shutters Q Windows/Doors
0 Electric El Plumbing Sprinklers El Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor: _
Cost of Construction: $ 3295.00 Utilities:1n Sewer 11 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �-�
Name:1 ✓� U��
Address: L.P0(001 PY&^I\& (_" k��AQ
ompany: � - �' , 2, e_ G- -�
Address:
City: P�C" P1- State: f
Zip Code: q Fax:' - l�-1
City: �� e «-� State: FL_
Phone No - - 4�
Zip Code: 3�t9 Fax: 77,?— 72
a ,
I
E-Ma=simple
$ neNo.\���- �j77-31. i
Fill inTitle Holder on next page (if d erent
E-Mail: P11% L ��'�"' '� ' Coen
from the Owner listed above)
State or County License: 7q %
If value of construction is $2500 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: _ Not Applicable
BONDING COMPANY: Not 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 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 your Notice of Commencement.
Signature of Owner Lessee/Contractor as Agent for Owner
Signature of Con ractor/ icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this A! day of OC to 6z2 20(7 by
this t� day of Oc-b b< r 2011 by
dicole AaIti+e,
/yiGhde, /4-qc,
Name of pe so making statement
Personally Known OR Produced Identification
Name of per on making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public -State of Florida )
Commission No. ;:t"'^4': NICHOLNeAPONTE
Commission No.�� ''r '• NICP- -1tX A[9&MXF-
=' MY COMMISSION 0 FFS63031
_�: "''' M�' :�? :....•• ;rJ s : Fr33031
'tea,; •. EXPIRES May 04, 2020
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REVIEWS
SUPERVISOR
PLANS
VEGETATION
J
MANGROVE
FRONT
ZONING
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17