HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: `- J ' cUSD Permit Number: (JLJ lU�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPEIP TANK
PROPOSED PMPROVEMENTaLOCAT ON ,r,,�i"
Address: 12776 NW Mariner Ct Palm City, FL 34990
Property Tax ID #: 4425-603-0029-000-7 Lot No.
Site Plan Name:
Project Name: Wolff Generator
Install 500 gallon underground LP tank with gas line to generator and final connect
Block No.
Additional work to be perforp�ed 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: $ 3995.00
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER%LESSEE".: , v �fm H�taG
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CQINTRACTOR`
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NameCharles Wolff
Name: Blake Cowdell
Address:12776 NW MarinerCt
Company: Energized Gas
City: Palm City State
Zip Code: 34990 Fax:
Phone No.7723362920
Address:1786 SW Biltmore St
City: Port sT Lucie State: FL
Zip Code: 34984 Fax:
Phone N0772777813
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail propanegasl4@gmail.com
State or County LicenseFL34747
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.
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:
Zip:
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 FINANCING, CONSULT
WITH YOUR LENDER OR N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signs ure of Owner/ Lessee/ ontractor as Agent or Owner
Si ure of Contractor/Lic nse Holder
STATE OF FLORIDA
STATE OF FLO A
COUNTY OF_ q
COUNTY OF �[ :J
The or instru t as acknowledged,pefore me
this I dayof � !(i:
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Name of person making statement.
Name of person making statement.
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Personally Known "�'< OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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