HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONM1y
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: �111 1 Permit Number:
JAN 0 7 ^919 S(
Building Permit Applicatio
Planning and Development Services ST. Lucie County, Peg4ttng,
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
PROPOSED IMPROVEMENT LOCATION:
Address: 8036 Kiawah Trace
Legal Description: Pod 25 At The Reserve
Property Tax ID #: 3327-705-0020-000-3
Site Plan Name:
Project Name: Modell
Setbacks Front — Back:
Right Side: Left Side:
Run gas line from existing tank to generator and final connect
0HVAC ki Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 795.00
nit —Checka apply:
Piping Shutters
ars 11 Generator
S Ft. of First Floor: _
Utilities:I]Sewer 0Septic
Lot No.19
Block No.
❑ Windows/Doors
11 Roof = Roof pitch
Building Height:
OWNER/LESSEE: '
'CONTRACTOR:
Name Steven & Betty Modell
Name: Blake Cowdell
Address:8036 Kiawah Trace
Company: Energized Gas
City: Port Saint Lucie State: FL
Zip Code: 34986 Fax:
Phone No.772-214-0213
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
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
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 ress: d252 Bandy BNd
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 rec'orddiin our Notice of Commencement.
- A
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA4�
STATE OF ORIDA j
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The forgoing instrument was ack owledg d efore me
this A day oofp�L' 20 by
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The for oing instrument was a knowledgg efore me
this da1y/ofn 201 by
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Name of p r n making statement
Personally Known f- OR Produced Identif' ation
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Type of den ication
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y My Commission Expires
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�',?„ �o;•' My Commission Expires
July 12
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COUNTER REVIEW REVIEW
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Rev.8/2/17