HomeMy WebLinkAboutBuilding Permit Application-GrimesAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8/10/2020 Permit Number:
`, L L L� fti Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
PERMIT APPLICATION FOR: Install 500 Gal. U/G LP Tank & exterior gas piping
PROPOSED IMPROVEMENT LOCATION:
Address: 3609 S Indian River Drive
Property Tax ID #: 2426-413-0003-000-3
Site Plan Name: Grimes
Project Name: Grimes, Susan (The Electrical Experts)
DETAILED DESCRIPTION OFWORK:
Install 500 gallon underground LP tank with exterior/underground LP Gas piping
to Generator (Permit # 2007-0683)
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.4
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical _L/Gas Tank ZGas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing — Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1,800.00
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Grimes, Susan F.
Name: Brian M. Critoph
Address: 3609 S Indian River Drive
Company: C&C Diversified Services
City: Fort Pierce, FL State:
Zip Code: 34982 Fax:
Phone No.772-210-6100
Address: 7954 SW Jack James Drive
City: Stuart State: FL
Zip Code: 34997 Fax: 772-266-4679
Phone No 772-266-4680
E-Mail: grimesusan@aol.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail susan@ccdiversifiedgas.com
State or County License L121079
If value of construction is 2500 or more, a RECORDED Notice of Commencement 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:
City: State:
Zip: Phone:
Address:
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 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 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 commencinR work or recording our Notice of Commencement.
Signature of Owne Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Florida
COUNTY OF Florida
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
X Physical Presence or Online Notarization
this 10 day of August 2020 by
this 10 day of August 2020 by
Brian M Critoph
Brian M. Critoph
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known X OR Produced Identification
Type of Iden 'fication
Type of Identifi ation
Produce
Produced
G n.
ignature of Nota #?u ;Sa
gnature of Notary P�-' o0
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REVIEW
REVIEW
DATE
RECEIVED
DATE
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