HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
j' ' a
r 'f L.
�' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1579
PERMIT APPLICATION FOR: j
PROPOSED IMPROVEMENT LOCATION:
ddress: �14-01 5 (Z"Vor �� ilcfk
Property Tax ID #:`7 I
Site Plan Name:
Project Name:
r g r 0 - 0-clo IS Lot No. --
Block No.
DETAILED DESCRIPTION OF WORK:
- 1 1±0 I
gf-2a T-C A-)(-, r CA rA f K
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical X Gas Tank _ Gas Piping J Shutters Windows/Doors Pond
Electric — Plumbing — Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction; Sq. Ft, of First Floor:
Cost of Construction: $ Z3CTE- 0 0 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i 4 ' Pfi R (�C'C,ti
Name:! 'd
Address: -D( �Si� 1eN IZiV<f b('
Company. C lqp-
City: State:
Zip Code:, ��y Fax:
Phone No.
Address: {—&�,tt-
City: Rc+ 5f , _ Stater
Zip Code: E-91 Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
,I VtlIUC up LUJVIuucE1vn is c5w or more, a Kti, urcutu Notice or Lommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and instaIIatian 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recordirg your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF L V Cl e
Sworn to (or affirmed) and subscribed before me of
Ph*cal Presence or Online Notarization
this LLC day of J U Y) 4 2020 by OW
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF ,V C V6 e
Sworn to (or affirmed) and subscribed before me of
Y Physical Presence or Online Notarization
this
� day of Ian 2020 by
env t J f' cLnue. Tv cr
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produce
( nature of Notary P
Notary Public State of Florida
Commission Na. M3AyC�l23Bd34
'kL Expires 07MMM
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced Identification
Type of Identification
Produced
{Signature of Notary Public -
Notary Pubw Slate of Flonda
Commission No, �p^Covrtietl
CyG 236434
Expires 07MWD22
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
THOMPSON
The Trusted dame in Propane
hffp://www.thomi2songes, com
Proposal / Agreement
Kimberly Pruitt
6601 S Indian River Drive
Fort pierce, Florida 34982
Phone (772)349-2206
04/28/2❑
Thompson Gas hereby agrees to furnish all labor and materials necessary for the
completion of services as specified below.
I. Price is to Supply and install Leased (1)1000 Gallon UG
tank
2. Supply and Install gas line to Generator BBQ Range and VV/H
3. Lease Charge will be $120.00 per year
4. Price includes labor, material, permitting and drawings.
S. Price does not include bonding gas line or carbon/smoke
detectors
For the sum of: $2a39�-00
1786 SW Biltmore St., Port Saint Lucie, FL, 34984 '"Licensed & Insured FL34747
Tall Free 855-PROGAS4 *Treasure Coast 772-777-8133 *Palm Beach 561-752-4214 *Fax
772-206-3606
TERMS:
Charges & Payments: Charges are due in full at time services are rendered unless otherwise stated below.
Contractor may charge and customer agrees to pay a late fee for all past due payments, such fees not to
exceed the maximum allowed rate by applicable law. Customer shall be responsible and agrees to pay for all
charges billed, applicable taxes, applicable legal fees and other charges/fees, Proposal/Contract pricing good
for 30 days from Proposal/Contract date
$1,197.50 clue @ Signing
$1,197.50 due at completion
We appreciate the opportunity you have extended us to quote on this work
and would like to thank you in advance for your consideration.
Authorized signature:
Joseph Giancontieri
RXW-C4
11 U/77 (printed name), authorize
Thompson Gas to cdrnplete the work in accordance with the above specifications and
conditions. I agree tq4;�" as p��3s outlined above,
Sig
Thank you for choosing Thompson gas Inc
"Serving the East Coast of Florida"
This agreement shall be construed under the laws of the State of Florida. This agreement contains the entire
understanding of the parties and supersedes ali previous verbal or written agreements: there are no other
agreements, representations or warranties not set forth herein. If any conflicts exist in this agreement between
terms which are printed and those which are typed or written, the
typed or written language shall govern.
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with standard
industry code.
Thompson Gas, Inc, is not responsible for landscaping repairs as a result of installation*.
This includes but is not limited to; damaged/broken sprinkler lines and/or damaged/broken
water or sewer lines.
This contract price does NOT include bonding gas lines, converting outlets, converting
appliances or carbon monoxide detectors unless otherwise stated above
Additional charges may apply if rock and/or roots are encountered during the excavation
process.
Deposit will be forfeited if customer cancels after the permit process is initiated
Customer is responsible for obtaining HOA/POA approval. Thompson Gas, Inc. is not
responsible for customers failing to obtain final approval.
If home is located in a flood zone, the additional cost will be the responsibility of the
homeowner if a tank tie down, or buoyancy pad is required per the building department
A site survey of your property showing all property lines is required to pull a permit 'and can
be submitted along with this signed proposal.
*To include sod replacement a charge of $395 applies.
CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE TERMS
IP A
S ATU RE
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