HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf
ALL APPLICABLE
IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Dat I �cl (CANINED Permit Number: I l
_ [BY
RAY
Building Permit Application "ermlttin 6?018
Plan n and Development ServicesA®
Build g and Code Regulation Division t @Ig �� dent
2300��irginia Avenue, Fort Pierce FL 34982
Pho ,e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential k
PERMIT
APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P.ROP�OSED
IMPROVEMtNT LOCATION'..
Address: E52-9 !�1-,- +Or bl�sS %1 CAI' '
Legal I escription:- CIL -p>10+- 13
J A1 -C, UnI4 19 or c9P� 11 -- 0
,f ?Ap' �i • OCR - 3 of No.
i Prope yTax ID #: `I� l�,lt� � � I � � � L
Site Plan n Name: I� �"I���� Block No.
Project)I Name: L
j Setba `!ks Front Back: Right Side: Left Side:
DETA�ILED`-D:ESCRIPTi'O:Ni.-OF' WORK':
$--
-Ci Yam-( rono-ec-f-
CONSTRUCT
ION INFORIVIATI.ON'''
-
_.
iti
c na workto e jet orme under
this permit —check
❑Gas Piping
a apply:
Shutters
❑ Windows/Doors
VAC asTank
_
E
ectric 0 Plumbing
Sprinklers
FIGenerator
Roof Roof pitch
Total S
. Ft of Construction:
S . Ft. of First Floor:
Cost of
Cost 04
onstruction:
onstruction: $ / !
Utilities:
Sewer Septic
Building Height:
OVVN�R/LESS--
-
' CdNTRACTOIT,
Name
Addres
City:
Zip Co
Phone
E-Mail:
Fill in
from tf�e
,
I���i ���
Name: Blake Cowdell
Via`....
: � `-'l 4�I�t 1 L'Q S,^ 1
Company: Energized Gas
C1 _ State:f-L— l
l 1
II ' ' Fax .,
No. "�
Address: 4252 Bandy Blvd.
Fort Pierce .' FL
y: State:
Zip Code: 34981 Fax: 772-318-6672
Qietie'N8. 772-466-1095
..�1�
I
I ; ;e simple Title Holder on nett page (if different
Owner listed above) '
E -Mail: ed
State or County License:
11 If value Of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
,SUPPL-ME:NfTAL CO
DESIGNER/ENGINEER:
"VW, .IINFO;RfVIA, I'0`NI .
Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: -
Ad d ress: 4252 Bandy Blvd.
City:
Zip: Phone:
MORTGAGE. -COMPANY: Not Applicable
Name: Blake Cowdell
Address:.'.. I
City: Fort Pierce State:
Zip: Phone:
BONDING COMPANY: Not Applicable,
Name:
Address:
City: I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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-build5the 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. ;i
Inconsideration 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. ji
The following building permit applications are exempt,from andergorng a full co'ncurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another.hon-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 anal. 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 your Notice of Commencement.
Signature of Owner/, Lessee/Contractor;as Agent for Qwn,er
STATE OF FLORID
COUNTY OF 1---U�-
The r of trum t asAnowledged6efore me
this ay of r20-t-%&hy
SIG ILA v.1d►� l
Name of pe making statement
Personally Known Ix OR Produced Identification
Type of Identification l I` l , LR�
Produced 1(5onn `-'�
Signature of Contractor/License Holder
STATE'OF FLORIDA
COUNTY OF�
The o' strum t was a kn wledged fore me
thi y of- A i t �, 20 y
�toA e, ov oiaT (
Name of pekso5making statement
Personally Known OR Produced Identification
Type of Identifica
Prod e��o-Ono—1
J✓ 1
(Sign)ture of Notary Public- State of Florida) ig atu of Notary Public- State of Florida )
ComVVmission No. (Seal) Comm ion No. ���iiil'I'I��i�i (Seal)
REVIEWS F 01. N 0 TZt(�I'�HI i =SUPERVISOR ZNS. ' VEG�1A 101�l� oil i-Ti t MANGROVE
CaUNTERo V IEW: REVIEW REVIEW RE5l[Ek pU L VIEW _ REVIEW
UA I t
RECEIVED �.s � M. r_� 1561�P '�i���c�` .......
COMPLETED
Rev. 8/2/17
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