HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r� 2
Datel: 0— �p `tK Permit Number: MCI- b � - e
:14,t [J rI_ Oct l;s
Building Permit Application 1018
Planning and Development Services Perm"017
Building and Code Regulation Division ' 4ys o �P p f
23001 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Gas tank—j
Pf3,OPOSED 11MPROVEMENT LOCATIt?N j s .�^At�tr>,,
Address: 7101 S Indian River Dr
Legal Description: Olmstead Place S/D
Property Tax ID #: 3412-502-0011-000-5
Site Plan Name:
Project Name: Julie Arnold
Setbacks Front Back:
Install;80 gallon LP Cylinder
Right Side: Left Side:
County
Lot No.10
Block No.
CO:NSTRtJCTIQN INFORMATIONT
Additional work to ever orme under
this permit - check
a
apply:
0HVAC
Ri
Gas Tank
Gas Piping
_
Shutters
❑ Windows/Doors
❑I
_ Electric 0 Plumbing
Sprinklers
0 Generator
Roof Roof pitch
lTotal Sq. Ft of Construction:
S . Ft. of First Floor:
Cost of Construction: $ 699.00
Utilities: LJ
Sewer
Eheptic
Building Height:
=OWNER%LESSEE
CONTRACTOR,
NameAnn Berner
Name: Blake Cowdell
Address:7101 S Indian River Dr
Company: Energized Gas
City.. Fort Pierce State: FL.
Zip Code: 34982 Fax:
Phone �No.772-201-7883
Address: 4252 Bandy Blvd
City: Fort Pierce State: FL
Zip Code: 34981 Fax: 772-318-6672
Phone No. 772-466-1095
E-Mail':
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: EnergizedGenerators@gmail.com
State or County License: FL34747
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPXPLENTAL
CO(VSTRUCTION
LIEN LAWINF
° *R'n%IA
IDN yx n^ k
s • i
DESIGNER/ENGINEER:
Name: Ann Berner
_ Not Applicable
MORTGAGE COMPANY:
Name: Blake Cowdell
Address: 7101 S Indian River or
City: Fort Pierce
Zip: Phone:
_ Not Applicable
State:
Address: 7101 S Indian River or .
City:' Fort Pierce State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
4252 Bandy v 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 recordina? vour Notice of Commencement.
of Owner/
as Agent for Owner I Sigri'51T< of Contractor/License Holder
STATE OF FLORIDA I j u�A � I STATE OUNTOY OFORID ,q/'►�
COUNTY OF L
The or oing inst
this ioKdav of
20
me
Name of pe s n making statement
Personally Known OR Produced Identifi tion
Type of Iden 'fication
Prod !ce
(Signature of otary u ' -01ATR9XBLACKSH EAR
,.State ppf Flgqnda-Notary Public
Commission No. Com4�g)on # GG 237887
'+ o My Commission Expires
0ii��`` July 12, 2022
REVIEWS I FRONT
I COUNTER
DATE
RECEIVED
DATE I
COMPLETED
Rev. 0/17
The or oing instrument was acknowledged before me
this day of ( r Anln e— , 20 )by
�Ekl li��___ C-61 Cy I
Name o p rso making statement
Personally Known OR Produced Identification
Type of Identi cation
Producen ! I 17 01
(Signature of tary TI:
ALYSSA BLACKSHEAR
��� State of kNotar Publii
Commission No. _: �= �@@ y7' Commi slon # GG 237887
'%'�o F.�� My Commission Expires
gat 101; July 12, 2022
ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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