HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION TOBEACCEPTED
Date: Permit Number:
' Building
' Permit Application
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Planning and Development Services
Building and Code Regulation Division
230Virginia Avenue, Fort Pierce B34982
Phone: /772\462-15S3 Fax: /772\462'1S7D COM1Ole[Ci8l Residential
PERMIT APPLICATION FOR: Ga's tank rF9
Address. 12U0NVVWINTERS CREEK ROAD
Legal Description: HARBOUR RIDGE PLAT 17TRACT G10GAND PINE VILLAGE LOT 4
4423'7U1'0O
Prope�yTax |D#: u�'"""U8'OOO' '
'Site Plan Name:
Project Name'WEIR
Setbacks Front �Back: Right Side: Left Side:_________ �
INSTALLl000 LP TANK TO GENERATOR AND FINAL CONNECT
Lot No.
Block No.
Al
Additional work to be performed under this permit —check
11HVAC Z Gas Tank E]Gas Piping
all
apply:
Shutters
Windows/Doors
FlElectric El Plumbing
OSprinklers
Generator
Roof Roof pitch
Total Sq. FtofConstruction:
of First Floor:
Cos ofCoostnucbon:$
'
Ub|hiest]Sewer [-]Sepdc
Building Height:
OWNER/LESSEE:.
CONTRA
Company: ENERGIZEDGAS'
Address: 1206 WINTER
City: PALM CITY State: FL
Phone No.'772-877-3440
E-Mail:jennifer.energized@gm8i].com
Fill in fee simple Title Holder on next page (if di . fferent
from the Owner listed above)
Address: 425�_:BA1N.bY'dLvb'
Zip Code: 34981 Fax: 772-318-6672
Phone No. 772-877-3440
E-Mail: JENNIFER.ENERGIZED@GMAIL.COM
State or County License: FL34747
Ifvalue ofconstruction is $2SODormore, aRECORDED Notice p*Commencement mrequired.
i
SUPPLEMENTAL'CONSTRUCTION'.LIEN`CAW INFORMATION
DESIGNER/ENGINEER: _INot Applicable
MORTGAGE COMPANY: _ Not Applicable
N a m e: DARCY WEIR
N a me: Robert Binkowski
Address: 1206 NW WINTERS CREEK ROAD I
Address: 1206 WINTERS CREEK RD
City: PALM CITY I State:
City: FORT PIERCE State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:4252 BANDY BLVD I Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
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 Owne is 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-9jopk or recording our Notice of Commencement.
I
Signatur of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Lice se Holder
STATE OF FLORIDA j �i I �i �•e
STATE OF ORI
COUNTY OF
COUNTY OF
The r i h'instru jye�s acknowledged before l e
�By
The m nowledg o e me
this of li 20�`�y
this d y of 20
Name of per o making statement I
Personally Known OR Produced Identification
Name of pmaking statement
Personally Known OR Produced Identification
Type of Identif�icatinn� 1 r Q� ,I(�
Produced Y�y�f ���l,Y�'L��% �� L�►li1/�n
I
.
Type of Iden ' 1 i
Produced .
A(Sigt
Sig at re of Nota Public- State of Florida)
re of o@, 3xv Iic�statpe of
Florid )
CORSON
Commission No. :p!JENNIFEWOORSON
� , •••,c
Com ssion I � * Commlaslon #GG 156t deal)
w * Commissfon # GG 155192
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'oar" Ben96d Tft k0 R Noie�'seiW=
`Qe Explres 000ber30, 2021
Service,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
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Rev.8/2/17
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