HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1,.
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ) 1 1 `� Permit Number:
RECEIVED
o '
® Building Permit Application JAN 0 7 2019
Planning and Development services ST. Lucie County, Permittin
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential /y
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION: SCANNED
123 Queen Isahella Ct BY
Legal Description: Queens Cove -Unit 1-
Property Tax ID #: 1414-701-0008-000-2
Site Plan Name:
Project Name: Reynolds
Setbacks Front Back:
I DETAICE:D DESCRIPTION OF WORK:
Right Side: Left Side:
Remove existing tank and Install 500 gallon LP tank A— {,;,, e . 0
NFORMATION':
OHVAC ki Gas Tank
1-1 Electric 0 Plumbing
Total Sq. Ft of Construction: _
Cost of Construction: $ 3700.00
Lot No.i
Block No. 1
L ^e
Piping L_IShutters Windows/Doors
nklers 0 Generator Roof = Roof pitch
Sq. Ft. of First Floor: _
Util ities:Sewer 0 Septic
Building Height:
-,OWNER/LESSEE:,
CONTRACTOR:
Name Sharon $ Donn Reynolds
Name: Blake Cowden
Address: 123 Queen Isabella Ct
Company: Energized Gas
City: Fort Pierce State: FL
Zip Code: 34949 Fax:
Phone No.772-519-2132
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 $2500 or more, a RECORDED Notice of Commencement is required.
JU,YKLtIVItIV IAL I..VIVJ I.. KW_ I IUIV:LICIV LHVv miruKIVIH I IU.IN
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
Name:
Ad d ress: 4252 Bendy Blvd
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
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 contlict 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.
d✓ .GEC U
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA c � I l /I /J
STATE OY ORID
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COUNTY OF ` 7T \ IS C I
COUNTOFc,T�l✓ Yet"
The forgoing instrument was acknowledg efore me
The forgoing instrument was acknowledged before me
thislday of . 20 obi �
thi day qf� 20by
Name of persso9 ma ing statement
Name of peVon making statement
Personally Known 7S OR Produced Identifi ion
Personally Known OR Produced Identification
Type of Identification
Type Ida ification
Pro uc
Pro c d
AJ
(Signature
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(Sign'at to Public- State of Florida j
:^" a,,, ALYSSA 13 A 1 SIIr'AR
nda-N public
Commi
,"' o, ALYSSA BLACKSH
Commi id - �l
- Commission @ GG 237887
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y ,_ -Notary public
- Commission N GG 237
w ,.o:= My Commission Expires
'•,',bra„oa° My Commission Expires87
I 12 2022
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Rev.8/2/17