HomeMy WebLinkAboutPERMIT APP - 5385 CHRISTENSEN RDAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
.S._ aL -a
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
PERMIT TYPE: GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 5385 CHRISTENSEN RD
Property Tax ID #: 3405-700-0002-000-5
Lot No.
Site Plan Name: HORTON Block No.
Project Name: HORTON
DETAILED DESCRIPTION OF WORK:
EXTERIOR LP GAS LINE FROM EXISTING LINE TO NEW GENERATOR LOCATION
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank XGas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 800 Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Dennis Horton
Name: Cheyenne Ellison
Address:5385 Christensen RD
Company: Elite Gas Contractors
City: Fort Pierce State:
Address:2130 Poma Drive
_
Zip Code: 34981 Fax:(772)220-1829
City: Palm City State: FL
Phone No.(772)220-9678
34990
Zip Code: 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
E-Mailemcintosh@elitegasco.com
from the Owner listed above)
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 TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Aolos_ e�V/
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Signature of C tractor/License Holder
Signature ofPrier/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrumepipas acknowledged before me
The forgoing instrument was before me
this 2�day of V/ L^-y 20 at by
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this � day of 20�by
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Name of rson makings tement.
Name of Arson maki�tement.
PersonallyKnown OR Produced Identification
PersonallyKnown OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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