HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED, rl 4ri
Date: 12/20/17 Permit Number: )
SCANNED r, E�, -�
BY P❑C
Building lge rfilfhpplication DEC 2 9 2017
Planning and Development Services
PER.10ITTING
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential yes
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION.
Address: 16675
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: Cespedes Residence
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAhLED DES:CRIPTibN OF 'WORK:
Installation of (2) 1000 gallon unde-rgrround L.P. Gas tanks and lines.,&7hiyam,/>rs /ocGf�o(
zp�SrP- a e. 4,,7
;CONSTRUCTLON INFORMATION
er orme under this permit - check
Additional work to be Z
FIVAC Gas Tank ✓ Gas Piping
a apply:
Shutters
a Windows/Doors
_
Electric 0 Plumbing
r Sprinklers
F-1 Generator
EiRoof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $ 5,000.00
Utilities: Sewer Septic
Building Height:
.01NNERJLESSEE.
'CONTRACTOR:'-' �
Name oenis Gespedes
Name: Hick Ravnar
Address: 16675 U-24 CanalCompany:
as Contractors, Inc.
City: State: _
Address: 1955
Zip Code: Fax:
City: Palm Beach Gardens State:
76-8
Phone No.
Zip Code: Fax:
E-Mail:
Phone'No. 772-201-8083
Fill in fee simple Title Holder on next page (if different
E-Mail: Rhavnar(c—oya oo.com
from the Owner listed above)
State or County License: 04840
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required:
SUPPLEMENTAL CONSTRUCTI'.ON LIEN LAW INFOR'NIATION
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:
Zip: Phone:
City:
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 our Notice of Commencement.
Signature of O er/ Lessee/Contractor as Agent for Owner
Signature of Con ractor/Li ense Holder
STATE OF FLORIDA
STATE OF FLORIDA,-3
I wX e ee e h C,
COUNTY OF
COUNTY OF
The for oing instr ment was acknowledgelbefore me
The f rgoing instr ment was acknowledged before me
this o� day of O 20 by
this day of C 20� by
ICE [���
Name of pe son making statement
Name of pers n making statement
Personally Known OR Produced Identification ��
Personally Known V OR Produced Identification
Type of Ider0acation
Type of Identification
Produced
Produced
i
ASHLIE M. GITLIN
er Publlc - State M Florida
(Signature of Notary Public- State of Florid )
(Signature of Notary P €>♦ - bf Ffts)Slon # FF 208170
�•, p.�;= My Comm. Expires Mar 10, 2019
Commission No. I,���������., KA S. NIELSEN
Commission No. 'OBondedt tlonalNotaryAssn.
- Commission # FF 115637
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®Pam; My Commission Expires
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SUPERVISOR
REVIEWS
FRONT
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17