HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1� 1 �Permit Number: RQ
BY
UCfL �:ovol E01
RECEIVED
Building Permit Application
Planning and Development Services JAN 31 2018
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Gas tank j
PROPOSED IMPROVEMENT LOCATION:'
Address: Z5�-1-LY �pY A( I LKXJY 1 :T( I I .
Legal Description: ��V' @ jki2r-2b-UV-L1::"'
Property Tax ID Lot No.
Site Plan Name: (b r Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
z- .,.. T
DETAILED DESCRIPTION OF,WORK:=, r..} Ir`
0,0 , '9Q t I on- L-P (�-�as
-J-,I-n fa+or -PnoJ ccor-)eC-�-
CONSTRUCTION INFORMATION:
Additional work to be pertorme under this permit - check all apply:
11HVAC tp
asTank ❑Gas Piping _ Shutters Windows/Doors
11 Electric umbing Sprinklers I Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction:; -. S Ft. of First Floor:
Cost of Construction: $ ... ") Utilities: _ Sewer �Septici,: Btuilc�ing Height:
OWNER/LESSEE: -
"
CONTRACTOR:
Name eJ
Name: [LOO-)5 I
Address:��R 440WI
-TKO l
,)
Company: 6C.� 1
City: �I `r°
Zip Code:3 Fa : ��
Phone N- J44Q
State
ddress:�
City: I�C� State:f L
//Zipp Code: 3�
IXne No. -3
E-Mail• Yl • n�- QI •�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mai )Ud
otunty
State License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN-1AW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
—Not Ap i licable
City:
Statg:
Zip: Phone
I
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Aiplicable
Address:
City:
I
Zip: Phone:
I
MORTGAGE COMPANY: _ Not'Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 Flori a 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 intendlto obtain financing, conwith lender or an attorney before
commen2ft work or recording vour Notice of Commencemen . ies u/ . �,
Signature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIA 1 (t
STATE OF FLORI 1 , I �,��
L
COUNTY OF CST- I—�-��
COUNTY OF
The i instru .was acknowledge I fore me
20
The for�jq�+-stru t w s knowledged ore me
thO �fd'ay of 20 lAby
thi ay of y
I I -
_r
_2L A W C!t��
_J4
Name of r n making statement)
Name of pNTn making statement
Pe so ally Known OR Produced Identification
Per Ily Known OR Produced Identification
Type Iden ' ' ti r� /���
Ty p f Identif'c ti n^'f ��
CJ l C �UV 1
of i/ /► ®1 n
Produced � � I(Ji V v
Produced 1--�",
Y Poe JE
��o G
Commission # G 156192
Y PO JENNIFER OR N
2o�c�;• .B`%
Commission#'GG156192•
*
Expires October 30, 2021
*
* Expires October 30, 2021
(Signature ki f otary ub ic- State of Florida)
(signatureRy Me e o orida )
i
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
I
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
RECEIVED
DATE
COMPLETED
Rev. 8/2/17