HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-- 7
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
,q 1 1 Date: 5 a� �. Permit Number:
,�%^A&AAIAk_m
t: Ely
St Lucie C
Building
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEIVED
rmit ApplIcatiatY 2 5 2018
ST. Lucie County, Permittl
mmercial Residential X
PERMIT APPLICATION FOR: Gas piping I ;-
PROPOSED IMPROVEMENT
� LOCATION:
Address: as I UCJI Ln i
A -,
Legal Description: -(CA-_1051— D I d
Property Tax ID #:
Site Plan Name: _
Project Name:
Setbacks Front
Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�r1 c� I qe�e .x�S� 1►'Y� 2
�5 hUX11 Ccou-o-
Lot No.
Block No.
CONSTRUCTION INFORMATION:
itiona wor to be erformed under this p mit - check: all apply:
OHVAC _ Gas Tank Gas Piping { In Shutters ❑ Windows/Doors
I
Electric ❑ Plumbing Sprinklers I E] Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: 1 S . Ft. of First Floor:
Cost of Construction: $ 99 o Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
a
Addre : L-ri
Company:
Address:
�V
`
City: S �)(�l�l Stater
Zip Code: 3qQXV Fax:
City:
State,
Phone No.mG(���.p
Zip Code:
Fax:
E-Mail:
Phone No. OLD
E-Mail
1045
li'
Fill in fee simple Title Holder on next page ( if different
'State or County icense:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LPw INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address:
City: State: I
City: State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
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 tip 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 lundergoing 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 No
improvements to your property. A Notice of Comi
before the first inspection. If you intend to obtain
commencing work or recordin our Notice of Co
:e of Commencement may result in your paying twice for
encement must be recorded and posted on the jobsite
nancing, consult with lender or an attorney before
mencement.
I
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
I..UGI C.
STATE OF FLORIDA �
OF �GfQ
COUNTY OF
COUNTY � 3t� •
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
� day Uay 20J by
this"day of IAI.a.V 20fff by
this of
lak+z c it
!?Ioe &(All
Name of person making statement
Name of person making statement
Personally Known )�.— OR Produced Identification
Personally Known D` OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature o
-
I
(Signature of Notary Public- State of Florida )
v"" N HOLE APONTE
Commission
,y, '. MY COMMISSION
Commission No. :;�'-!�'• NICHQLF.S4&PNTE
'•'.�;'orti'`' EXPIRES May 04,.2020
"•c MY COMMISSION # FF863037
398-C'S3 noridallotaryswv;w.com
EXPIRES May 04, 2020
(4071303.0' S3
rJorldallotarySon
ko.com
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tev.8/2/17