HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPI'
) FOR APPLICATION TO BE ACCEPTED
Date: 7/8/19
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number: 1 -6 U 7 �
SCANNED
St Lucie
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PERMITTYPE:GAS PIPING I
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Address: 1933 OLD DIXIE HWY. / 1936 N. 3RD ST
Property Tax ID #: 2403-602-0009-0004
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
INSTALL GAS PIPING FOR NEW GAS FIXTURES. NCJ sFOJe &Aa /12V
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 500.00
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name CAROL KAHLE gbc/ (A or.
Name: CHRIS JOHNSON
Address:2710 WALKER DR (Je ---fx &tcl
Company: CNJ PLUMBING LLC
City: FT. PIERCE State: _
Zip Code: 34982 Fax:
Phone No.772-528-2806
Address:1701 S. 37TH ST.
City: FT. PIERCE State: FL
Zip Code: 34947 Fax:
Phone No 772-801-3073
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail CHRISJOHNSON@FPUA.COM
State or County License 30950
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTLJLIEN 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
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCIN90 CONSULT
WITH YOUR DER OR AN ATTO EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/C actor as Agent for Owner
Signature of Contractor License Ho
STATE OF FLORIDA �
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The forgoing instrument was acknowledged before me
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this 10 day of 204 by
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Name of person making statement.
Name ofmaking statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
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Rev. 21 // 19