HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 `�L��l� Permit Number:
JAN 2 2 2019
Building Permit Applicatio
Planning and Development Services ST.. Lucie County, Permitting
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 SCAN
ED
PROPOSED IMPROVEMENTLOCATION: Ngy
Address: 221 Emerald Ave mot. Lucie County
Legal Description: West Fort Pierce Estates- Unrecorded Plat in Sec 9-35-39
Property Tax ID #: 2309-801-0006-000-5 Lot No. 6
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
['DETAILE_D DESCRIPTION OF WORK:
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tCONSTRUCTION INFORMATION:
Itlona wor to De�, net orme under this permit— c ec a apply:
E]HVAC L• I Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
11 Electric 1:1 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: � S Ft, of First Floor:
Cost of Construction: $ c3/'�' (J Utilities:5ewer Septic Building Height:
OWNER%L'ESSEE;
CONTRACTOR:
Name Robert Binkowski
Name: Blake Cowdell
Address:221 Emerald Ave
Company: Energized Gas
City: Fort Pierce State: FL
Zip Code: 34945 Fax:
Phone No.
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.
0
SUPPLEMENTAL.CONSTRUCTION LIEN LAW INFORMATION -
DESIGN ER/ENGIN EER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 recording vour Notice of Commencement.
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Signs a of Owner/ Lessee Contractor as Agent for Owner
SignatWof Contractor/License Holder
STATE OF FLORID /�
STATE OF FLORID J �r
COUNTY OF Yt�. .� III I l" _
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The oing instrument was acknowled ed before me
of 20
thi day of 20, by
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Name of person m:TORPro
Name of person making statement.
Personally Knownduce Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
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DATE
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