HomeMy WebLinkAboutPERMIT APP 6-4-20All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/4120
COUNTY
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
PERMIT TYPE:GAS
PROPOSED IMPROVEMENT LOCATION:
Address:
n�nc nnA[ hAAMNIFR rtT
Property ax ID * 4425_R03-0015-000-6
T
Site Plan Name: CARR
Project Name: CARR
DFTA1LED DESCRIPTION OF WORK:
EXTERIOR LP GAS TANK AND LINES
CONSTRUCTION INFORMATION:
Commercial Residential X
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical yGasTank DGasPiping_Shutters _Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2000 Utilities: _ Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Michael 6 Carr
Name: Cheyenne Ellison
Company: Elite Gas Contractors
Address: 12795 NW Mariner Ct
Address:2130 Poma Drive
City: Palm City State: _
Zip Code: 34990 Fax:(772)220"1829
772 220-9678
Phone No.( )
City: Palm City State: -FL
Zip Code: 34990 Fax: (772)220-1829
Phone No(772)220-9678
emcintosh@elitegasco.com
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail emcintosh@elitegasco.com
State or County License 18361
If value of construction is $ZDUU or more, a REwnv=•. •-^^••-••-- - ---- -
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _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
. Arrnooev DEFORE RECE!R HC Vn11D NOTIrF nF COMMENCEMENT."
Rev. 2///19
Signature of Cont ctor/License Holder
Signature of ownLessee/Contractor as Agent for Owner
STATE OF FLORIDA��y
STATE OF FLORA
V\A C�r
COUNTY OF AA r � i` 1 �
COUNTY OF
Thefar oing instru ent was acknowledged before me
[T
The for oing instrume t was acknowledged before me
20—ClOby
this day of 200 Oby
this day ofd.
C_.r,,.e vt.t_e_ 4�: 0 Q t fro V_
< s.n �a _ 4.2 Q.I�X-cS w
Name of p on making atement.
Known OR Produced Identification
Name of p son making s atement.
Name
Personally Known OR Produced Identification
Personally
Type of Identification
Type of Identification
Pr duced
Produced
(Signature of ry Public State of Florida )
a)
(Sign re of ry Publi -Ft
,rs��a.� SS�{{ to of Flonda
Commission No. 'rettl�toshCommission
vM Nota Public 4Eiealli'londa
No. nission
GG 283399
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REVIEWS
FRONT
SUPERVISOR
PLANS
VEGETAT O
A
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2///19