HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICBLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J 1 p SCANNED Permit Number:
13Y
St Lucie Coin*
RECEIVED
Building Permit Application JAN 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. a County
Phone: (772) 462-1553 'Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Gas tank
F-91
L-il —
PROPOSED IMPROVEMENT LOCATION
%
1 4
Address: 140e
Legal Description:
P_ 914 c
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Ila C� r
-r-
e
1-CA 0-
21e_�e 0
Back: Right Side: Left Side:
F�W., kk,
DETAILED DESCRIPTION OF
aIqs40_j1 I(Doo C-jal Ion L-P Ccas -TcLn
gener cti-or -- _�)not C_�neC4-
Lot No.
Block No.
ONSTRUCTIONANFORMATIOW,
4.
-A-Mitional worK to be rTormed under this permit- check all apply:
11HVAC Gas Tank 0Gas Piping r) Shutters Windows/Doors
11 Electric RPlumbing OSprinklers E]Generator E]Roof Roof pitch
Total Sq. Ft of Construction: 0
Cost of Construction- $ Aq-5. �__
S of First Floor:
—
11Ft
Utilities: Sewer Septic
Building Height:
OWNER/,LESSEE: '�CONTRACTC)Rt
NameNJ
Name:
Company:
Wd.LAddress:
F-11 M e
14040.
City: Qf_(2'
f 4 PWE 1 ;7- I `�ia'ie:ftl
J
Address: VGQ
L6 1 -
Zip Code: 34q4�5 Fax: W090-
city: h0b: 0141-, 1� StatekL-
,,,
Phone No. '1101;_fffl_ I
Zip Code: Fax:
No.
E-Mail: (hdn
Fill in simple Title Holder on next page ifdiE-Mail:
0l,
IfflnHr-Y, Mk(OlUT-04(y
State oqounty'License: F-L314-
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
DESIGNER/ENGINEER: _ Not Applicable'
Name:
MOR'i,GAGE'COMPANY: _ Not Applicable
Name'c
'.Ad,dress:
Address:
City: State:
Zip: Phone
City: F State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:'
BONDING COMPANY: Not Applicable
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
commencin rk
,or_rec_Qrding your Notice of Commencement.
Signat,6re o Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA (�
UI
STATE OF FLORf4 j-. - i
COUNTY OF
COUNTY OF (
�
The f t en a a owledge for
Th ru s acknowledged ore me
thi 20� by
this day o 20 by
l
Name of making statement
ojilly
Name of per n making statement
Pe Known OR Produced Identification
OR Produced Identification
Personally Knowig�vlcutqw
Type of Identific i� n L ( ;� / N, ✓1
Produced w Ln V
Type of Ide if'
Produced
t
r
I
gnatu of Notary Pub c- State of Florida)
(Sign t re of Notary Pu lic- State o rida )
gag ;Pze JENNIFER CORSON
Commission Commisslon#GG15610al)
a JENNIFER CORSON
Commissiora 'P g -p GG156`lgSeaI)
Q Expires October 30, 2021
+
Q Expires October 30, 2021
c
'4F Fcd� DmdedTluu BaWN011Y ServlCeS
'
�9 @` N0 Sery M
Bonded llru Budge► 1ary
REVIEWS
FRONT
i
ZONING'
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW;
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17