HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONm
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I
N..
s RECEIVED
• Building Permit Application NOV 13 ?.019
Permitting Depar n gnt
Planning and Development Services St. Lucie COMRty
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone,: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIIT APPLICATION FOR: Gas tank-
Cf'ANI\I�1� ' ~'
Address: 16183 Carlton Adams Rd
Legal Description: Luke's Lots (PB 41-4)
Property Tax ID #: 2236-700-0009-000-3
Site Plan Name:
ProjectIName: Swain
Setbacks Front Back:
Right Side: Left Side:
e
Lot No.9
Block No.
DETAILEAn'DES;CRIPTION OF WOaRK
Install bUU Gallon LP Tank with (4) gas drops to (2) tankless water heaters, BBQ, and Range
Electric Q Plumbing
Total Sq. Ft of Construction:
Cost of! Construction: $ 5495.00
❑Sprinklers Generator
S Ft, of First Floor: _
Utilities:cnSewer Septic
Roof Roof pitch
Building Height:
A0INNER/LESSEE"CO
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Name William & Rita Swain
Address:16183 Carlton Adams Rd
Name: Blake Cowdell
Company: Energized Gas
City: Fort Pierce
Zip Code: 34945 Fax:
Phone iNo.
State: FL
Address: 4252 Bandy Blvd
City: Fort Pierce State: FL
Zip Code: 34981 Fax: 772-318-6672
Phone No. 772-466-1095
E-Mail:
I
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 $2500 or more, a RECORDED Notice of Commencement is required.
Sl1PPLE`MEN°TAL CONSTRUCTION LLEN LAIN#IN,FQRMATION, . x K
r ..,k"�s, d a.•. ��`^ w. Vrv-'. �k�•� tea,
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
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Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name..
Name:
Ad d re$s: 4252 Bandy Blvd
Address:
City:
City: i
Zip: Phone:
I
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 folloiwing 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
comme
.n_cing work or rec4ding your Notice of Commencement.
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Sign re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF f�lLLAC��
COUNTY OF ( �l
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
day of NOVOM b4W 20)S by
tXIVXV
this � day of MoVeNK hs,r 2d by
;�*'ay�"
lrA
Name of per on making statement =o
°4Apt• ��"5
a Name of pers n making statement _=
Known
Personally Known OR Produced Identification
�1
sonally OR Produced Identification
Type of Identification
T e of Iden 'fication
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Prod 3 3 �
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(Signature o Notary Public- State of Florida) N o z
ignature of otary Public- State of Florida) :N o z
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Commission No. (Seal) w�
ommission No. (Seal) ^N'rn
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
I
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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