HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p
Date: Permit Number:
Building Permit Application I
JAN 0 7 2pig
Planning and Development Services 4T` EualA Eetlnt Perm
Building and Code Regulation Division _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Gas tank n Ill
IMPROVEMENT LOCA
Address:
Legal Description:
Property Tax ID#:1J0I'g%I'ryA(_D'=)" A Lot No. `1l0
Site Plan Name: Block No.
Project Name: C in&, Qn&rce SCANNED
Setbacks Front Back: Right Side: Left Side: BY
St. Lucie Count,
DETAILED DESCRIPTION OF WORK:
Sc pply 13D ��cc c n LpcC r_ro rwnv Lp to Yl_
UuIi-h I Inp � to01,( c_cS LAXLr_r I)e_Atcr' Gnu i Inca ecnrVcf—
CONSTRUCTION INFORMATION:
nnmona wor to a orme under t-checkispermit a apply:
11HVAC LUGasTank []GasPipingIn _Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers FIGenerator D Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 9,�-PS • W
S Ft. of First Floor:
: _
UtilitiesSewer FISeptic
Building Height:
OWNER/LESSEE: '
CONTRACTOR:
Name WrrM C( I nCx-
Name:
Address.-Ici35 P1c1Yt-1Cthcri W16es Dr
Company: I'G
City: R- r 5+7-wic�_4 State:
Zip Code: Si4qitp Fax:
Phone No.Tq— J )b- CTI S I
Address:HOPSn- &OC
6) Y
City: State:_r�_.
Zip Code:3`4 ( Fax:
Phone No. ma- q(�t0 I UGS
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ('1Y ,l I u6cr_nc
�iazs ?=Qhi
< t-ca
r
State or Coun y License:
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City: �
City:
Zip: I Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifythat 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 recording your Notice of Commencement.
AJtC/YU , L r�M ,
�l '
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA,::Zt
STATE OF FLORID
COUNTY OF �1 La�
COUNTY OF Ir i^C .
The f9xgoing inst u pent was acknowledge before me
The fgrgoing ingr a was acknowledged before me
thi day of, 20 by
this C day of 204 by I
�of
Name of pe n making statement
p rso ma king. statement
Personally Known P OR Produced Identification
Personally Known OR Produced Identification
Type I edlification
Type o ent' cation
Pro c d
Prodded
n
(Si o 'd
State of Florida )
(Signatuivy
Co a ALYSSA BLACKSHEA
I)
_ s' 4$oState of Florid - ary Pub
CommissLYSSA BLA REAR
oaGG 237887
y Commission Expires
MJuly
rate of Florid a -Notary Public
Commission # GG
12 2022
237gg7
MY Comm'
my 1z, 202
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATIO
OVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.9/2/17