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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ca•QS- (D Permit Number: � I © O t>� Building Permit Applicatio Planning and Development Services FEB 2 5 2020 Building and Code Regulation Division L ucie County, Perrr 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X PERMIT TYPE: GAS PROPOSED IMPROVEMENT LOCATION: Address: 11001 S INDIAN RIVER DR Property Tax ID #: 3532-503-0030-000-6 Site Plan Name: POLHEMUS Project Name: POLHEMUS DETAILED DESCRIPTION OF WORK: ADDING NEW INTERIOR LINE FROM EXISTING STUB AT RANGE/DRYER CONSTRUCTION INFORMATION: Lot N0.2 & 3 Block No. 3 Additional work to be performed under this permit— check all that apply: _Mechanical _ Gas Tank _kGas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ 800 Generator Roof Pitch Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: NameTheresa Polhemus Name: Cheyenne Ellison Address:11001 S Indian River DR Company: PROPANE SERVICI�S INC / DBAI Elite Gas Contractors City: Fart Pierce State: _ Zip Code: 34982 Fax:(772)220-1829 Phone No.(772)220-9678 Address:2130 Poma Drive City: Palm City State:FL Zip Code: 34990 Fax: (772)220-1829 Phone No(772)220-9678 E-Mail:emcintosh@elitegasco.com Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mailemcintosh@elitegasco.com State or County License 18361 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 CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable BONDING COMPANY: Name: _Not Applicable 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE DL�MMENCEMENT_" _0!:�) J;A�� Signatu of Owner/ Lessee ctor as Agent for Owner Signat Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTYOF MO.Y+n COUNTYOF nncur+-iyl The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this _19 day of Petnn� 20a0 by this J_S_ day of F2hrUat r!, 20QO by Gyleaeylv�e �llIS'o9 be�,ye�o-,e EJliSan Name o arson making statement. Name of person makings tement. �OR Personally Known � OR Produced Identification Personally Known Produced Identification Type of Identification Type of Identification Produced P uced ( Ignatu f otary P r % Notary Pa lic State of Flodde (Signature f ary Pu a e o f ry Notary blic State of Florida Commission No. Desirr�Pp N M�tcIntosh My Cdsl Lon GG 283399 f �; Desir e N McIntosh Commission No. QTF + My C Ian GG 283399 +paw Expires l2l1t2022 aw� ExPnes 12n 12022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED nev. y11.<7