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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t� Date: I Permit Number: 1$ 0 -1 r O-1,15 S 'ANNED BY .. Lupie 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: To Select from dropbox, click arrow at the end of line FROPOSED� IMPROVEMENT LOCATION: -- Address: Q -I � 1q� TLC "PI Legal Description: Property Tax ID #: cn>334—'5D 41-0\ I, - QUA >- CO Lot No. Site Plan Name: _j 1Yl0 ri� -1�1 T�-� 1 I Block No. Project Name: Setbacks Front Back: Right �Side: Left Side: 1).ETAILED,,DESCR,IPTfON1 OF WORK"." gc%11 on 1,P +� ► -i i'Y_1 I C��r �r�C�-- - CO,NSTRU:CTI:ON INFOR"MATfON - -nertormed" itional work to e . un 11HVAC er t is permit - c ec ❑Gas Piping I a app y: Shutters Q Windows/Doors Gas Tank _ Electric D Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: Cost of Construction: $ Utilities: _Sewer Septic Building Height: OWNER/LESSEE: C© " T-MCTOR': Name l Name: Blake cowdell Address. Company: Energized Gas City: ` State Address: 4252 Bandy Blvd:::` , Zip Code: Fax: - -164tGCity: Fort Pierce .State: FL Phone No. 10- --1 Zip Code: 34981 Fax: 772-318-6672 E-Mail: 10 fi.yl I IVA I & P one No. 772-466-1095 Fill in a simple Title Holder on nexCpagef if different E-Mail: jennifer.energized@gmail.com State or County License: from the Owner listed above) IIf value of construction is $2500 or more, a RECORDED Notice of Commencement is regwreo. II ��SUPP i�EM'E�Nr AL��CONSTR ���CTI �,IVI,LIENrLA�W `I'NFQ:R�IVIAeTI�O'IVI: '� ' DESIGNER/ENGINEER: _ Not Applicable Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Add ress:4252 Bandy Blvd. City: Zip: Phone: MORTGAGE COMPANY: _'Not Applicable Name: Blake Cowdell Address: City: FortPlerce State: Zip: Phone: BONDING COMPANY: Not Applicable Name: Address: City: 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 1 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 vour Notice of Commencement. BAL COW" i Signature of Owner/ Lessee/Contractor as Agent for owner STATE OF FLORIDA COUNTY OF The f r oing instru nt was acknowled efore me this day of Q 20 by. LL . Name of pe n making statement Personally Known A OR Produced Identification Type of Idgr}iii�{cgtjor� nra r . �/ e ,� , , \ Produced CJi VL`� L.I 1�,��lJU of NotA Public- State of Florida ) Commission No. (Seal) C� ISSipNR� REVIEWS f R;AR1N11�G ' SUPERVISOR WuA11911 I C REVIEW REVIEW DATE RECEIVED 'I?#GG�S P��•`. DATE �ii�0'FI F i COMPLETED Rev. 8/2/17 911A - Signature of Contractor/License Holder STATE OF FLORID I �y COUNTY OF c�t IiI The f plume t s acl owledg efore me this rhy 20jKby Name of per9gii making statement Personally Known /1��.. OR Produced Identification Type of Ide}}f,?� &LL �—iProduced ( ig ture of Notary Public- State of Florida ) Commission No; .(Seal) N1F E IfflR �; \TURTLE, ' MANGROVE EVIEW , REVIEW