HomeMy WebLinkAboutFuel Gas.Jorgensen - 5619 Oleander Ave_App-NOC-ContractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
�'�lY Y n A lilll
�I
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential X
PERMIT TYPE: LP GAS
PROPOSED IMPROVEMENT LOCATION:
kddress: 5619 OLEANDER AVE FORT PIERCE. FL 34982
Property Tax ID p: 3409-111-0020-030-0 Lot No.
Site Plan Name: Block No.
Project Name: JORGENSEN
DETAILED DESCRIPTION OF WORK:
T
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit —check all that apply:
_Mechanical XGasTank XGas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 4314.35
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name CYNTHIA JORGENSEN
Name: Tom Fite
Address: 5619 CLFANDFR AVF
Company: Ferrellgas
city: FORT PIERCE State: FL
Zip code:33434 Fax:
Phone No. 772-201- 3686
Address: 3232 SE Dixie Hwy
city: Stuart state: FL
Zip code: 34997 Fax: 772-287-3456
Phone No 772-287-4330
E-Mail: Cindy@primerealty.net
Fill In fee simple Title Holder on next page ( If different
from the Owner listed above)
E-Mail KimVViIkins@ferreligas.COm
state or county License 31370
--- -•--••-••--••-•• •---..........v. c, . ncrvnvcv nwna yr wmmencemen{ Is requlrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
DESIGNER ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State: _
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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
WITtWOUR LENDER AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C MMEN EMENT."
11
inn�4is� L126
Signature of Owner/ Lessee/Contractor as Agent for Owner
Ignature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Martin
COUNTY OF Martin
The forgoing instrument was acknowledged before me
this 25tl11ay of June 2o220 by
The forgoing instrument was acknowledged before me
this25bday of June 2020 by
Tom Fite
Tom Fite
Name of person making statement.
Name of person making statement.
Personally Known ✓ OR Produced Identification _
Personally Known ✓ OR Produced Identification
Type of identifcatio
Type of Identification
Pro ced
Prodiced
( ignature of Not Public- State_ of on
KIFs3ER -Y L. WILKINS
Commission No. '�; rJ 44 I#FF 063105
I4.: 2021
tii(m,,ES: Novecber 28,
xrs
(Signatur of Not -
:•';vq KIM9ERLEY L. WILKINS
Commission No. FF0 . =: My CO S��(ON#FF 063105
_<- XP R S: No ember 28, 2021
=s = E I
^; E•b"�` eU Thm Notary Public Untlervrilers
REVIEWS
'—
COUNTER
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATI
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4723323 OR BOOK 4438 PAGE 529, Recorded 06/29/2020 03:01:40 PM
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56174045M Ed 25104
10m Wadn
T72 2874330 Eld 225M
Jam Canner
772 287 4330 EA 25101
3232 SE ohde Highway. SWatt FL 34997