HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-REVISIONALL APPLICABLE I FO MUST BE COMPLETED "8804IEFON TO BE ACCEPTED
Date: Permit Number:
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t�
ION
- - Building Permit Application MAY 10 2018
Planning and Development Services i
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: To Select from dropbox, click arrow at the end of line
P'R'OP'OSED� I•MPROVE.M' ENT LOCATION-:,
Address: a -1-74 Waf S n
Legal Description:
Property Tax ID #: 4�a�- 3 `I60c) 1 k--oco-e3 Lot No.
Site Plan Name: Block No.
Project Name: I_AC CdA
Setbacks Front Back: Right Side: Left Side:
DETAILED'.D.ESCRIPTIONQF WQRK� , ,
� 5 pry. , �— l ( t��O G�jCe l0�1. CAS `Tci-� V
:CQNSTRU'CTION INF'OR'IVIA_ TI'ON�:
Additional work to b
mer orme under this permit - check a apply:
GasTanGas Piping Shutters rs Windows/Doors ,k Q
EI-Electric' Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Ji S InSewer
of First Floor:
Cost of Construction: $ Utilities:Septic Building Height:
OWNER/'LESSEE:.
ACT CQNTR> .'OM
Name
Name: Blake Cowdell
Address: lam -1 4 L-tl n er, •
Company: Energized Gas
G
City: 1 C! �fY1 �Sttatcfi L_
Zip Code: 3q (RqD "- Fa GC 17 I'O"� v�l
Phone No. �2 ` q �O �� 5 • '
Address: 4252 Bandy Blvd.
City: Fort Pierce FL
_ State:—
ZipCode: 34981 Fax: 772-318-6672
YP4 ne No. 772-466-1095 ,. ,
/�)
E-Mail• "n I lr�l lie am011 •C
Fill in fee simple Title Holder on. "hext page ('if'different
from the Owner listed above)
E-Mail: jennifer.energized@gmail:com.
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Lommencemem: is requirea.
1
PPLEMENTAL CONSTRUCTI-N;:LIEN�LA�1N?INERj RIVIATION�.:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
> hlame:BlakQCowdafl
Address: " `
:Address:.
City: State: -
Zip: Phone
....City: Forte�a«. - State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Ad d ress: 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 you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA � (�
COUNTY OF
STATE OF FLORID ,I
COUNTY OF, rl`�
The instrume t as ack owledg efore me
this y of 20ID by
The instr e t was acknowledg fore me
this ' l da of 20y
Name of perk9n making statement
Personally Known OR Produced Identification'
Name of person making statement
Personally Known < OR Produced Identification
Type of Identifica 'o
Produced IYPRMna I l L4 ILn-®LA-! �
Type of Identification
Produced
of Notary Public- State of Florida)
(Sig ature of Notary Pu lic- State of Floridamission
11nature
No. (Seal)
om fission NcL `��N%C" IIUII���� (Seal).-,
.30
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REVIEWS_
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SUPERVISOR
REVIEW
PLANS
REVIEW
NOTARY
VQGE ONO
12 ( 1 1-I.0
FA TURTLE
;'RENEW
MANGROVE
REVIEW
DATE
RECEIVED
n%4Z4
�''• �q . �y #GG 166�
DATE
COMPLETED
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Rev. 8/2/17