HomeMy WebLinkAboutBuilding Permit ApplicationAFL APPLICABLE INFO MUST BE COMPLE'i ru FOR APPLICATION TO BE ACCEPTED
Date: \6 �►y 11� Permit Number:
RECEIVED
Building Permit Applical ion OCT 2 4 2017
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commerdiale$io r, FL
PERMIT APPLICATION FOR: Gas piping El I
PROPOSED IMPROVEMENT LOCATION:
Address: Y in -e
t"
c, ✓42,
F—ol'+ ` , .eleQ
Ft- 3 �lq5
Legal Description: Tn d c,&�
iZ% v^e r
e-5 (,
`
e-5 i;h % �/
to fk- 3&
Property Tax ID #: ZWA&05 067o2b00J Lot No. 7
Site Plan Name: Block No.3(,--,
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
S tvGi+, ve -1 IT poh��✓I e-
� en
CONSTRUCTION INFORMATION:
Additional work to e nertormed un er t isVas
— check a apply:
L�HVAC13 Gas Tank iping i _ Shutters []Windows/Doors
Electric 0 Plumbing Sprinklers Generator 11 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 9-6® �a
S Ft. of First Floor: _
Utilities:0Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r-�o�. 1.9 r.`
Name: gob
P
Address: —1 bQcl F 11 e
Company: _cvl e1 ' Zed
City: '1 6-cV P� �q_-e State: _
Address: &nAy P GE
Zip Code: JY'q?72 Fax:
city: Fo`i �.`t VCC_ State: F
Phone No. _ 7e2— 20 1'!-7ct-7
Zip, Code: v3 (M Fax: 172--3I9-&WA
E-Mail:
Phone No. 7oZ- &?2_5WO
Fill in fee simple Title Holder on next page ( if different
E-Mail: Fed ; 2.e � q�—,� ,Ic-,P it ra; . F a ""
from the Owner listed above)
State or County License: (' 3 L(7 c%'
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:
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 vour Notice of Commencement. - Z 11),
_ Signature
Agent
CorltVactor/License
STATE OF FLORI A STATE OF FLORJQA
COUNTY OF �-I LUCy COUNTY OF (,U C 1,
The f�o�r oing instru ent was acknowledg efore me The Tday
ing instru ent was acknowledged before me
this -il v-- day of 20�by this of 20 _a by
'9,0h,n koW 5y"i 1�0► - F �i►irI Kows Ali
(Name of person acknowledging) (Name of person acknowledging )
�-U
(Signature of Notary P blic- tate of Florida )
Personally Known OR Produced Identification
Type of Identification Prod
''•�� NICHOLE APON It:
Commissi FISSION # FFOOMP
EXPIRES May 04, 2020
398-0'53
Revised 07/15/2014
Ackat aAAVJ-
(Signature of Notary PPu lic- State of Florida )
Personally Known✓ OR Produced Identification
Type of Identification Produced
Commission No.
MY COMMISSION # FF963031
? •_ _:' . EXPIRES May 04. 2020
53
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