HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE
IKIIFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: SCANNED Permit Number: d 0021_ d°�
BY
St Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMP/R/O/VEMENT o-
Address:^- �r• 1
Legal Description: 1 �D "��� `�'�' 1��� L04- 1
Cor 31�3-1 Q) a 3 a
Property.Tax ID #: 3�21-- E- oI - Lot No.
Site Plan Name: rr n n Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIRTION O.F WORK xj
CONSTRUCTION INFORMATION
Additional work to 15 e e or under t is permit - c ec a apply:
11HVAC Tank ❑Gas Piping Shutters QWindows/Doors
Electric ��as
lumbing Sprinklers []Generator 0 Roof Roof pitch
Total .Sq. Ft of Construction: j S . Ft. of First Floor:
Cost of Construction: $ ��� oQ Utilities: -Sewer 0Septic Building Height:
OWNER/LESSEE _,
CONTRACTOR
Name (2>S rl�" '<1
Address: �g b.Cit-
.-A 1
City: Stated %_ ,
Name: O „-.
Company:
. ,.
Address:
Zip Co � F a
Phonelo�l i
City: ��
Zip Code:3 1
Phone Now -3
Stater
4-O
E-Ma'I: 1
ail:J.Plon
Fill in fee simple Title Holder on n pa e f difTeWhUl e-r-7
from the Owner listed above)
State or County License:
Z
If value of construction is $2500 or more, a RECORDED Notice 'of Commencement is required.
SUPPLEMENTAL "CONSTRUCTION LIEN LAW INFORMATIC+N
DESIGNER/ENGINEER: _ Not
Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:'
Address:
Address:
City: State:
City: I
State:
Zip: Phone
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: City:'
Zip: Phone: 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 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 resulfiri 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 rk or recording ur Notice of Commencement.
WIZA5
A
"I, .
Signa re of wner/ Lessee/Contractor as Agent for Owner
Signatu a of Cont ctor/L cense olde
STATE OF FLORID 1 1
STATE OF FLORIDA��
COUNTY OF I��
COUNTY OF �1-lJl
TheWrnstru was cknowleciI efore me
ggthisof 20by
efore me
The 0nqstrumg*was acknowled 11b
thisf 20y
T3 nIl-{iJ b
) I WWSl---;,
Name of p n making statement
n
Name of p making statement
Personally Known OR Produced Identification
OR Produced Identification
Personally Known OR
n q/
Type of Identifi atigno,[�
, .'1n
OU v
Type of Iden
Produced l
Produced
0
JA'
flm�
i ature of Not ry Public- State of Florida)
(Si n�at re o Notary Public- State o Florida) '
204PRYP�B`O JENNI CORSON
C mission No.
Pp pow, JENNIFERCORSON
Co i ion° �•.'� (Seal)
N'9 \or Explres October30,
OFF1.� iiorldedThNBwlgetl
Iv6192
2021.
missidirOGG 158192
Expires October 30, 2021
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REVIEWS
FRONT
ZONING,
SUPERVISOR
PLANS
VEGETATION'
SEA TURTLE ,
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW,
REVIEW
DATE
.RECEIVED
DATE
_71
COMPLETED
Rev.8/2/17'