HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICAB%fWTA,$EACCEPTED
Date: 8/5/16 I�HB''t�IIY�IV Permit Number:
St. Lucie Count,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division itt19 A�
2300 Virginia Avenue, Fort Pierce FL 34982 EC E 7 @M
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residentdal„ a
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 14191 Rangeline Road Port St Lucie FL 34987
Legal Description:
Property Tax ID #: 4233-111-0001-000/6 Lot No.
Site Plan Name:
Project Name: City West
Setbacks Fr
Back: Right Side:
Left Side:
�tTa.7�(a
DETAILED DESCRIPTION OF WORK: f
installation of new propane tank and piping
I' CONSTRUCTION INFORMATION III
HVAC IV Gas Tank UGas Piping
Electric 0 Plumbing []Sprinklers
Shutters Windows/Doors
Generator Roof
Total Sq. Ft of Construction:
�,/ry / S Ft. of First Floor:
Cost of Construction: s , 151 Utilities., Sewer O Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Cityof PortSt Lucie
Name: rQ4 O
Address: 121 SW :Port St Lucie Blvd
Company: Martin County Propane
City: Port St Lucie State: FL
Zip Code: 34984 Fax:
Phone No.
Address: 3586 SW Martin Hwy
City: Palm City State: FL
Zip Code: 34990 Fax: 772-287-5961
Phone No. 772-287-1900 l`Ar. �S
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: OSrJ 7
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
Name: AmecFoster& Wheeler Erwhonmentainfrastructure ine
MORTGAGE COMPANY: X Not Applicable
Name:
Address: 1075 Big Shanty Road suite too
Address:
City: Kennesaw State: GA
Zip: 3e144 Phone: 770421-3400
City: State: _
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 at orney before
commencing work or recordi your Notice of Commencement.
Sigriature of Owner/ Lea/Agent
.Sig_naWreof.!Con_r, c nse Holder
STATE OF FLORID
STATE OF FLOR
COUNTY OF �A ICA
COUNTY OF
The The for cing instru ent was acknowledged before me
The forgoing instrument was acknowledg�}d before me
�tZA
this day of Ao[IA�— . 20 �by
thikD day of _ _,20 l� by
(Name of person acknowledging
(Name of person acknoggwledg1ing )
l ��
(Signature 6f Notary\\ Public- Stat of F o—nda)
(Sig ature otary Public -State of Florida )
Personally Known OR Produced Identification
Perso ally Known OR Produced Identification
Type of Identification Pr uced
Type of Identification Produced
Commission No. Notaweal)iio State of Florida
Commission No. li.' i etAN t(S"wiN
Katrina J Slay
' - =. Nmaly Public -State of Florida
My Commission FF 072078
_ V ; .` Commission FF980222
'O'^" "N"" ' My Comm. Expires Jul 30. 2020
Revised07/15/2014 "•: .....�� Bonded through NationalNotuyAssn.
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