HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO
}MUST BE COMPLETED FOR
Date: A, E. N
TO BE ACCEPTED d
Permit Number: 1 O y C) rJ 0 D
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
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION
Address: IP015i
Legal Description:
Property Tax ID #: (3r_�I v
Site Plan Name:, I ��
Project Name:
Setbacks Front Back
RECEIVED
APR 19 2018
ST. Lucie County, gram
Commercial Residential
-!r L- wn I-�-- z) \ a i y _ �;, + Lo�s t
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
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ae\J f"kc, L c o r)n ecA—
CONSTRUCTION INFORMATION:
Additional work to e e orme un er this permit— check a apply:
�IHVAC 4Gas Tank ❑Gas Piping _Shutters ❑ Windows/Doors
Electric 0 Plumbing []Sprinklers O Generator F]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ l 15• d Q
S Ft. of First Floor:
Utilities:nSewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 17 In OF'
Name c2
Address:
Company:_&
City: State: !
Address•'15OG E6C ' 1
Zip Code: Fax:
City: FIDLL P(U C e— Stat (_1
Phone No.
Zip Code: �R1 Fax':���`�
Phone Noire `C
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed ' above)
State or County License: YYl
II If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable)
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
I
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone I
I
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
I
Name:
Address:
Address: I
City:
I
City:
Zip: Phone:
I
I
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 priorito 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
comaftcing work or recording vour Notice of Commencement.
Owner/ Lessee/Contractor as Agent for
STATE OF FLOIRIQCI
COUNTY OFF
I
The�trument as acovledefore me
thsfoy 2by j
Name of p r making statement
Personally Known OR Produced Identification
Type of Identificatfon
Produced
Sign ture of N�ogy��blic- ��J�,
c Commisslan iM 00 }�
Commission NIWA
iresOctol3
�,o� smmon�rr�p
re of Contractor/License Holder
STATE OF FLORI
COUNTY OF L3T—
The ftftrn st um w s <n wledge� a ore me
this 1 ay of 20_ y
to 1
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
of Notary Public -State of Florida )
tv�® JENWFERCORSoN (Seal)
*LrommL.ssion 9 Gu 150192
of Expires October 30, 2021
011
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE' MANGROVE
COUNTER I REVIEW REVIEW REVIEW I REVIEW I REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17