HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: WANNED) Permit Number: rc 5
n BY
St Lucie Coantr
Building Permit Application ✓AN 10 2018
Planning and Development Services ,
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 M1//
Phone: (772) 462-1553 Fax: (772),462-1578 Commercial Residential
PERMIT APPLICATION FOR: 'Gas tank �-
Address: ! 'm,<D 1__J1
Legal ascription: Aeof
Property Tax ID #:Site Plan Name: bl
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Project Name: I Our 6 ho, I r
Setbacks Front Back:
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Right Side: Left Side:
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Lot No._
Block No.
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11HVAC LyGas Tank ❑Gas Piping H Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers MGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $p`�. Utilities: _ Sewer E]Septic Building Height:
OWNER%LESSEaE
£.� N s ,
CONTRACTOR
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Name rG'
Name: r es- �n
Company: 1
Address: f' ®
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Address: Q� 01 I�IT`
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City: fhP-. PWYQ°P State` -L
Zip Code: Fax-77-LD)-0l0%a
City:
State:'
Phone No. 1 -g
Zip Code:
Fax: - 0-W-7
E-Mail: i 49
Phone No.� �
Fill in fee simple Title Holder on ext page( i ifferen
E-Mail:
State or County License:
from the Owner listed above)
Iit value oT construction is $Z500 or more, a RECORDED Notice of Commencement is required.
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StJPPLEMENTALCONSTRUC ®NLIENLuAU1/INF.ORMiAIIONi
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: Marsha Rubie
Name: Energized Electric
Address: 180501 Kitty Hawk Court
Address:18501 Kitty Hawk Court Fort Pierce FL, 34987
City: Fort Pierce
State:
City: Fort Pierce State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address: 4252 Bandy Blvd.
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 yob intend to obtain financing, consult with lender or an attorney before
commencing_wor1gor recording 'Your Notice of Commencement.
I
Signature ot Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA 0�
COUNTY OF l---I�it(`/��
COUNTY OF 1A"C
ore me
The f o'n 'ts5�ru a >1lwledgeft
this bay 20
The f nstru s a knot' lle ( e b e me
this day of ul�'10
of
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100J vvs
Name of pn making statement
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Name of pe,<n making statement
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Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification I V
Produced i�P�cJ _ r �J
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Pr d oeldden�r� l
(Sign ture of Notary Public- State of Florida)
(Sig to a of Notary P lic- State of Florida )
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o miss��ly�y�`� (Seal)
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Com ion No. -••'•• 1b8192
Commt4elbfili�
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NOSHO0M3JINN3P oar
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17