HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
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LL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 07/18/18
Permit Number:
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BY
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� Building �ermit Application
' Planning and Development Services
j Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
(PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
R,OPOS;ED IMPROVEMEIVT�LOCATION r � � �r ° `' "_ � � r
_
Address: 123 Queen Isabella CT
Legal Description: QUEENS COVE -UNIT 1- BLK 1 LOT J (OR 1055-2945)
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liroperty Tax ID #: 1414-701-0008-000-2 Lot No. J
Site Plan Name: Block No. 1
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Project Name:Reynolds
Setbacks Front so Back: 10 Right Side: 10 Left Side: 10
ICI
iPTF WORK DETALEDDESCRIION O
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UTILIZE EXISTING AND TEE OFF LINE AND RUN NEW LINE TO FUTURE GENERATOR SITE
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CONSTRUCTION INFORMATION "
_3. _ .e... ,.
itiona work to rformed under tispermit—c eck all appy:
LiHVAC n Gas Tank W]Gas Piping Shutters a Windows/Doors
11Electric 0 MGenerator
Plumbing Sprinklers Roof Roof p
i itch
of First Floor:
Total Sq. Ft of Construction: SIC nSewerE_1
st of Construction: $ 'b� !) (o . �jej Utilities:Septic Building Height:
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UU1%NER LESSEE -.� _.
-
"CoNTRACTt
flame F Donn Reynolds & Sharon Reynolds
dress: 123 Queen Isabella CT
Name: GAMALIEL PORTALES
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Ci11 ty: Hutchinson Island FL,
Company: FERRELLGAS
P Y�
State:
Zip Code: 34949
Address: 3232 SE DIXIE HWY
Fax:
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City: STUART FL
Y State:
Phone No.
Zip Code: 34997 Fax: 772-287-3456
-Mail:Jil
Phone No. 772-287-4330
F
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11 in fee simple Title Holder on next page ( if different
E-Mail: emilygalen@ferrellgas.com
f
m the Owner listed above)
State or County License: 01237
If
value of construction is $2500 or more, a RECORDED Notice of Commencement
is required.
DESIGNER/ENGINEER: _ Not Applicable
Name : THOMAS COLLINS
Ad d ress: 9519 LAURELWOOD CT. FORT PIERCE. FL 34951
City: FORT PIERCE' State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
N a m e: OAMA PORTALES
Address: 9519 LAURELWOOD CT.
City: STUART State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Add ress: 3232 sE DIXIE HWY Address:
City: City:
Zip: Phone:
Zip: Phone:
IWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
hich is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit.such
ructure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
consideration of the granting "of this requested permit, I do hereby agree that I will, in all respects, perform the work
accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
to following building permit applications are exempt from undergoing a full concurrency review: room additions,
cessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
IARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
1provements to your property. A Notice of Commencement must be recorded and posted on the jobsite
afore the first inspection. If you intend to obtain financing, consult with lender or an attorney before
►mmencing work or recording your Notice of Commencement.
11D,
re of Owner/ L ssee/Contractor as Agent for Owner Signature of Contractor License Holder
'ATE OF FLORIA
STATE OF FLORIDA,
)LINTY OF �� �r,� `�V'� COUNTY OF- - ` �' �-j 1,/ l
e for oing instrument was acknowledged.before me
ls"k1i day of ,_) Q WN , 20_1.�§", by
Name of person rtiaking statement
onally Known e., OR Produced Identification
of Identification
uced
ignature of Nc
Immission No.
EVIEWS
1TE
CEIVED
ffE
IMPLETED
8/2/17
The forgoing instrument was acknowledged,before me
this 1 gday of g �r I �-°° y 20Jy9 by
Name of persorf making statement
Personally Known ®,/ OR Produced Identification
Type of Identification
Produced
:a� (Signature of Nefary u t i... trite o on ALEN
;`ptY°�;• =be
4J �: - I YG
, - C462 Commission No. '�,: MYCOMM)SSIO'�j #GG 165462
EXP1 EXPIREJ�et?�h�
a;y ;•F. oa,• ber5,2021
'X V t��-a "� P,FF�.`° Bonded Thru No Public Underwriters
,oF :,``•' Bonded (ers
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